Podiatry Coding & Billing Alert

See how to code for patients with a non-pressure ulcer documented as healing.

CMS and the National Center for Health Statistics (NCHS) recently released the 2018 ICD-10-CM Official Guidelines for Coding and Reporting. In these Guidelines, you will find further direction on how to correctly report non-pressure chronic ulcers. As you may remember, in its list of the 2018 ICD-10 codes, CMS announced the addition of 45 new non-pressure chronic ulcer options.

The bottom line: Review the following quiz questions to learn the ins and outs of the 2018 ICD-10 codes and 2018 ICD-10 Official Guidelines, which will both go into effect on Oct. 1, 2017.

See What Non-Pressure Chronic Ulcer Codes the Guidelines Will Impact

Question 1: Do the guidelines apply to both the original and new non-pressure chronic ulcer codes?

Answer 1: Yes. The guidelines will apply to both the original and the new non-pressure chronic ulcer options. The new ulcer codes identify whether the patient's condition is "with muscle involvement without evidence of necrosis," "with bone involvement without evidence of necrosis," or "with other specified severity."

To see which codes the 2018 guidelines will affect, take a look at this original ICD-10 code: L97.30 (Non-pressure chronic ulcer of unspecified ankle).

Addition: ICD-10 2018 will add the following codes for the unspecified ankle:

• L97.305 (Non-pressure chronic ulcer of unspecified ankle with muscle involvement without evidence of necrosis)
• L97.306 (Non-pressure chronic ulcer of unspecified ankle with bone involvement without evidence of necrosis)
• L97.308 (Non-pressure chronic ulcer of unspecified ankle with other specified severity).

Mind Language Distinction Between Bone and Muscle Involvement

Question 2: Why is it important to understand the difference between "with bone involvement" and "with muscle involvement?"

Answer 2: Recognizing the distinction of "with bone involvement" versus "with muscle involvement" is vital because they help define the depth of the wound, which shows how much treatment may be involved, according to Jordan Meyers, DPM, partner at Raleigh Foot and Ankle Center and consultant at Treace Medical Concepts, Inc. in Raleigh, North Carolina.

The deeper the wound, the deeper the problem and the higher the risk of infection or need for surgery, Meyers adds.

Know Meaning of Necrosis to Ensure Proper Treatment

Question 3: What does "necrosis" mean, and why is it important?

Answer 3: Some of the new non-pressure chronic ulcercodes specify that the ulcer is "without evidence ofnecrosis," which gives a clearer picture of the patient's health.

Necrosis refers to how healthy a wound is, and it points to a likely inadequate perfusion to the wound (vascular issue), according to Meyers.

Arnold Beresh, DPM, CPC, CSFAC in Newport News, Virginia, adds that knowing if there is a sign of necrosis impacts how the podiatrist will treat the ulcer.

If there isn't sign of necrosis, the podiatrist doesn't have anything to debride as per the debridement codes' definition, Beresh says. So, in that case, the correct treatment would just be wound care.

Master How to Handle a Patient With Healed Non-Pressure Ulcer

Question 4: What do the 2018 guidelines say about reporting for an admitted patient with a non-pressure chronic ulcer the podiatrist documents as healed?

Answer 4: Do not assign a code if the documentation states that the patient's non-pressure chronic ulcer is completely healed, according to the Guidelines.

If Patient's Non-Pressure Ulcer Documented as Healing, Do This

Question 5: How should you code for an admitted patient with a non-pressure chronic ulcer the podiatrist documents as healing?

Answer 5: If the podiatrist describes the non-pressure chronic ulcer as healing, report the correct non-pressure chronic ulcer code based upon the information in the documentation, according to the guidelines.

However, if the documentation does not provide information about the severity of the healing non-pressure chronic ulcer, report the appropriate code for unspecified severity, the guidelines maintain.

If the documentation does not make it clear whether the patient has a current (new) non-pressure chronic ulcer or if the podiatrist is treating the patient for a healing non-pressure chronic ulcer, you should query your provider, according to the guidelines.

For ulcers that were present on admission but healed at the time of discharge, report the code for the site and severity of the non-pressure chronic ulcer at the time of the patient's admission, the guidelines add.

Non-Pressure Ulcer Progressed to Another Severity Level? Report 2 Separate Codes

Question 6: How should you report an admitted patient with a non-pressure chronic ulcer that progresses to another severity level during the patient's admission?

Answer 6: If the podiatrist admits a patient to an inpatient hospital with a non-pressure chronic ulcer at one severity level, and the ulcer progresses to a higher severity level, report two separate codes, according to the guidelines.

You would choose one code for the site and severity level of the ulcer upon the patient's admission. You would choose the second code for the same ulcer site and the highest severity level the podiatrist reported during the patient's stay.