Podiatry Coding & Billing Alert

Hint: Unspecified and unstageable pressure ulcers are not the same.

The 2021 ICD-10-CM Official Guidelines for Coding and Reporting offer helpful insights on the rules you should follow for reporting various diagnosis codes, including those for pressure ulcers. If you want to submit clean pressure ulcer claims in your podiatry practice, you must know what the guidelines say about these codes.

Follow these tips to keep your pressure ulcer claims in tip-top shape.

Tip 1: Sixth Character Identifies Pressure Ulcer Stage

When you report a code from category L89- (Pressure ulcer), you must know the exact stage of the pressure ulcer. “The ICD-10-CM classifies pressure ulcer stages based on severity, which is designated by stages 1-4, deep tissue pressure injury, unspecified stage, and unstageable,” according to the guidelines.

Take a look at the different pressure ulcer stages, which are identified by the sixth character in the L89 codes:

• 0: Unstageable
• 1: Stage 1 (Pressure pre-ulcer skin changes limited to persistent focal edema)
• 2: Stage 2 (Pressure ulcer with abrasion, blister, partial thickness skin loss involving epidermis and/ or dermis)
• 3: Stage 3 (Pressure ulcer with full thickness skin loss involving damage or necrosis of subcutaneous tissue)
• 4: Stage 4 (Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon, or bone)
• 6: Deep tissue damage
• 9: Unspecified stage

Coding example: Your podiatrist documents a stage three pressure ulcer of the left ankle. You should report L89.523 (Pressure ulcer of left ankle, stage 3).

Don’t miss: Code L89.523 also includes stage 3 healing pressure ulcers of the left ankle and pressure ulcers with full thickness skin loss involving damage or necrosis of subcutaneous tissue of the left ankle.

Tip 2: Know Difference Between Unstageable and Unspecified Pressure Ulcers

ICD-10-CM offers specific codes for unstageable pressure ulcers. These codes have a “0” as the sixth character. When a pressure ulcer is unstageable, this means that the physician cannot clinically determine the depth or stage of the wound. Examples of unstageable pressure ulcers, according to the guidelines, include when the pressure ulcer is covered by eschar or the physician has treated the pressure ulcer with a skin or muscle graft.

Unstageable pressure ulcer example: You look in your medical documentation and see the patient has a pressure ulcer of the right heel, but an eschar covered the wound. The podiatrist did not remove the eschar, so he documented the pressure ulcer as “unstageable.” You should report code L89.610 (Pressure ulcer of right heel, unstageable).

On the other hand, if you see that a pressure ulcer is unspecified, this means the op report doesn’t give you any documentation about the pressure ulcer’s stage.

Unspecified pressure ulcer example: Your podiatrist diagnoses the patient with a pressure ulcer of the right heel, but in the op report, he doesn’t give you any documentation about the stage of the pressure ulcer. In this case, you should report L89.619 (Pressure ulcer of right heel, unspecified stage). Code L89.619 also includes healing pressure ulcers of the right heel NOS and healing pressure ulcers of the right heel, unspecified stage.

Tip 3: See Distinction Between Completely Healed and Healing

If your podiatrist admits a patient with a pressure ulcer that he documents as completely healed, then you should not report a code in this case, per the guidelines.

On the other hand, if your podiatrist documents a healing pressure ulcer, you should report “the appropriate pressure ulcer stage code based on the documentation in the medical record,” according to the guidelines. If the medical documentation does not give you information about the healing pressure ulcer’s stage, then you should report an unspecified stage code.

If the documentation isn’t clear about whether the patient has a current (new) pressure ulcer or if the podiatrist is treating the patient for a healing pressure ulcer, you should query your podiatrist.

Finally, if the patient had a pressure ulcer when he was admitted, but the ulcer healed by the time he was discharged, you should report the appropriate code for the pressure ulcer’s site and stage at the time of admission, per the guidelines.

Tip 4: Rely on This Guidance for Evolving Pressure Ulcers

In some cases, a patient’s pressure ulcer may evolve to a higher stage.

For example, your podiatrist admits a patient into an inpatient hospital with a stage 3 pressure ulcer on her right ankle. During the patient’s stay, the ulcer progressed to a stage 4 ulcer. You should report the following two codes on your claim:

• L89.513 (Pressure ulcer of right ankle, stage 3) for the site and stage of the pressure ulcer on admission
• L89.514 (Pressure ulcer of right ankle, stage 4) for the same ulcer site and the highest stage reported during the patient’s stay in the inpatient hospital

Tip 5: Turn to These Codes for Pressure-Induced Deep Tissue Damage

As mentioned above, a sixth character of “6” in the L89- codes indicates deep tissue damage.

For example, if the patient has pressure-induced deep tissue damage of the right heel, you should report L89.616 (Pressure-induced deep tissue damage of right heel).