Podiatry Coding & Billing Alert

Consider the ulcer’s type and condition upon admission.

Encounters involving non-pressure ulcers are a common occurrence in a podiatrist’s work. However, the frequent contact with these conditions does not necessarily guarantee their accurate reporting and reimbursement.

Below we will take and in-depth look with a Q&A session to help you identify which CPT^® and ICD-10-CM codes correctly apply to a variety of non-pressure ulcer scenarios.

Question 1: What are the ICD-10-CM code options for chronic non-pressure ulcers affecting the foot, ankle, and toe?

Answer: You should look to the following codes for non-pressure chronic ulcers of the foot, ankle, and toe:

• L97.3- (Non-pressure chronic ulcer of ankle)
• L97.4- (Non-pressure chronic ulcer of heel and midfoot)
• L97.5- (Non-pressure chronic ulcer of other part of foot) (This category also includes non-pressure chronic ulcer of the toe.)

Coding note: Remember to code ulcers to the 4th, 5th, and 6th characters. The 4th character identifies the location, 5th the laterality, and the 6th the severity. “If the patient has diabetes, a common situation for patients with foot ulcers, be sure to first code from the series E09-E13.621 followed by the appropriate non-pressure chronic ulcer code,” says Ruby O’Brochta- Woodward, BSN, CPC, CPMA, CDEO, CPCO, CPB, COSC, CSFAC, CPC-I, coding educator.

Question 2: How should I code a non-pressure ulcer with muscle necrosis?

Scenario: Upon examination, the podiatrist identifies and documents a non-pressure ulcer with muscle necrosis on the patient’s right midfoot. The patient is prepared and anesthetized, followed by an extended cleansing of the ulcer. Using forceps and scissors, the podiatrist removes the necrotic material and damaged tissues from the skin and muscle layer, encompassing the skin, subcutaneous tissue, fascia, and muscle. Tissue is excised from the wound until healthy, bleeding skin edges are visible. The bleeding is then managed, an antibiotic applied, and the wound dressed. The size of the wound is 4.0 cm x 3.5 cm.

Answer: You should report L97.413 (Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle) for the ICD-10-CM code. The necrosis indicates that there is likely inadequate perfusion to the wound — a vascular issue. According to Jordan Meyers, DPM, partner at Raleigh Foot and Ankle Center and consultant at Treace Medical Concepts, Inc. in Raleigh, North Carolina, necrosis is an indication of the wound’s health status and typically suggests a vascular problem causing insufficient blood supply to the wound.

For the CPT^® code, you would report 11043 (Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less). “Encourage your providers to document any comorbidities/ causations such as diabetes, PVD [peripheral vascular disease], etc. which can ultimately affect the overall management and outcomes,” says O’Brochta-Woodward.

Question 3: How do I handle healed non-pressure ulcers during a patient’s hospital admission?

Scenario: My podiatrist admitted a patient with a non-pressure chronic ulcer of the right heel and midfoot limited to breakdown of skin, but the ulcer healed at the time of admission. Can I report code L97.411 (Non-pressure chronic ulcer of right heel and midfoot limited to breakdown of skin)?

Answer: No. You shouldn’t report any code if your podiatrist’s documentation states that the patient’s non-pressure ulcer was completely healed at the time of admission, according to the ICD-10-CM Official Guidelines for Coding and Reporting.

Question 4: How should I code for a healing non-pressure ulcer?

Scenario: My podiatrist noted that an admitted patient has a non-pressure chronic ulcer that is healing. How should I report this on my claim?

Answer: There are many ways to handle this, all of which depend on the information contained in the practitioner’s notes. Here are a few examples:

Option 1: If your podiatrist describes the non-pressure chronic ulcer as healing, you should report the correct non-pressure chronic ulcer code based upon the information in the documentation. For example, you read in the medical documentation that the patient has a healing non-pressure ulcer of the right ankle limited to breakdown of skin. You would report L97.311 (Non-pressure chronic ulcer of right ankle limited to breakdown of skin) in this case.

Option 2: If your podiatrist’s medical documentation doesn’t mention the severity of the patient’s healing non-pressure chronic ulcer, you should instead report the appropriate code for unspecified severity. For example, the medical documentation states that the patient has a healing non-pressure chronic ulcer of the right ankle. However, because the severity of the non-pressure ulcer is not mentioned in their documentation, you would report L97.319 (Non-pressure chronic ulcer of right ankle with unspecified severity).

Option 3: If your podiatrist’s documentation is unclear as to whether the patient has a current (new) non-pressure chronic ulcer or whether your podiatrist is treating the patient for a healing non-pressure chronic ulcer, you will need to query your podiatrist for further clarification.

Option 4: In cases where a patient was admitted with an ulcer that healed by the time of discharge, the corresponding ICD-10-CM code for the location and severity of the non-pressure ulcer upon admission should be used. For example, let’s say you read in your podiatrist’s documentation that the patient was admitted with a non-pressure chronic ulcer of the right ankle with fat layer exposed, but the ulcer had healed by the time your podiatrist discharged the patient, you would report code L97.312 (Non-pressure chronic ulcer of right ankle with fat layer exposed).

Helpful tip: Refer to ICD-10 guideline I.C.12.b.1-3 for guidance on diagnosis coding when patients are admitted with a healed non-pressure ulcer, a healing non-pressure ulcer, or one that has progressed in severity during admission.

Question 5: How should I code a non-pressure ulcer that became more severe after the patient was admitted?

Scenario: My podiatrist admitted a patient to the hospital with a non-pressure chronic ulcer of the right heel and midfoot limited to breakdown of skin. However, the ulcer progressed to a higher severity level during the patient’s admission; it moved to having the fat layer exposed. What code should I report?

Answer: In this case, you should report two separate codes: one code for the site and severity level of the ulcer on admission, and a second code for the same ulcer site and the highest severity level reported during the patient’s stay. So, the first code you will report is L97.411 (Non-pressure chronic ulcer of right heel and midfoot limited to breakdown of skin). Then, you would report code L97.412 (Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed) to represent the highest severity of the ulcer.