Podiatry Coding & Billing Alert

Hint: Always code associated gangrene first, for pressure ulcers, if applicable.

Patients who are confined to a bed, chair, or wheelchair for a prolonged period of time often suffer from pressure ulcers, which occur from prolonged pressure on the skin. You may see patients with pressure ulcers in your podiatry practice because these ulcers often develop on the skin that covers bony areas of the body like heels and ankles.

Read on to keep your pressure ulcer claims in tip-top shape.

Rely on Category L89- for Pressure Ulcers

Question 1: Which ICD-10 codes should I report for pressure ulcers?

Answer 1: You should look to category L89- (Pressure ulcer) when reporting pressure ulcers. Pressure ulcers are also known as bed sores, decubitus ulcers, plaster ulcers, pressure areas, or pressure sores because these are all included conditions you will find under L89-.

Always Report Associated Gangrene First

Question 2: My podiatrist documented that the patient has a stage 3 pressure ulcer in his left heel, with associated gangrene. How should I code this?

Answer 2: You should always check for any associated gangrene when reporting pressure ulcers and code the associated gangrene first, according to ICD-10. So, in this case, you would first report I96 (Gangrene, not elsewhere classified) for the associated gangrene, then L89.623 (Pressure ulcer of left heel, stage 3) for the pressure ulcer.

Fourth Digit Indicates Anatomic Site

Question 3: What does the fourth digit of L89- indicate?

Answer 3: The fourth digit of L89- indicates the pressure ulcer anatomic site, such as the hip or heel.

You should always report the most specific ICD-10 code supported by your podiatrist’s documentation. That means you should reserve L89.9- (Pressure ulcer of unspecified site) for cases when the podiatrist does not document where the pressure ulcer is at all.

Don’t miss: Coders should also be aware that coding L89.89.- (Pressure ulcer of other site) is not the same as coding L89.9.- (Pressure ulcer of unspecified site). As Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico, explains it, “Other site’ means that the provider has indicated where the ulcer is, but there is no specific code under L89.- that specifies the site documented.” “L89.9-,” Witt continues, “would mean that the provider has not documented where the ulcer is at all.”

Example: If the patient has a pressure ulcer on his heel, you would look to codes in the L89.6- (Pressure ulcer of heel) set. On the other hand, if the patient has a pressure ulcer on his ankle, you would look to codes in the L89.5- (Pressure ulcer of ankle) set.

Podiatrist Performed Debridement? Do This

Question 4: The podiatrist performed debridement of a stage 1 pressure ulcer in the patient’s right ankle to allow the wound to stay open and heal. He debrided the subcutaneous tissue, including the epidermis and dermis, of 15sq cm of the ulcer. What ICD-10 and CPT^® codes should I report?

Answer 4: You should report L89.511 (Pressure ulcer of right ankle, stage 1) for the ICD-10 code. For the debridement, you should report 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less).

Don’t miss: Code L89.511 also includes the following conditions, according to ICD-10:

• Healing pressure ulcer of right ankle, stage 1
• Pressure pre-ulcer skin changes limited to persistent focal edema, right ankle.

Discover Severity of Pressure Ulcer

Question 5: Which character in ICD-10 indicates the severity of the pressure ulcer?

Answer 5: ICD-10 categorizes pressure ulcers by degrees of severity, known as stages. The stages correlate to the depth of the tissue damage. The sixth and final character of L89- codes describes the stage of the ulcer. ICD-10 provides descriptions of each stage, as follows:

• 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)
• 5: Unspecified.

Example: If the podiatrist documented a stage 4 pressure ulcer of the left heel, then you would report L89.624 (Pressure ulcer of left heel, stage 4). As you can see, the sixth digit of this code is a “4,” which indicates that the pressure ulcer is stage 4 with necrosis of soft tissues through to underlying muscle, tendon, or bone.

Code L89.624 also includes the following conditions, according to ICD-10:

• Healing pressure ulcer of left heel, stage 4
• Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon, or bone, left heel.

Differentiate Between Unstageable and Unspecified

Question 6: What is the difference between unstageable and unspecified regarding pressure ulcers?

Answer 6: Unstageable is not the same as unspecified, according to the ICD-10 guidelines.

In some cases, the surgeon can’t clinically determine depth or stage of the wound because slough and/or eschar cover the wound bed, often enabling the wound to heal. For that reason, the surgeon may choose not to remove the covering just to determine the stage and would designate the pressure ulcer as “unstageable.”

On the other hand, “unspecified” means that the op report offers no documentation about the stage of the pressure ulcer.

Follow This Advice for Evolving Ulcer Stages

Question 7: The patient was admitted into the inpatient hospital with a stage 1 pressure ulcer on his right heel. During his stay, the ulcer progressed into a stage 2 ulcer. How should we handle this situation?

Answer 7: If a patient is admitted to an inpatient hospital with a pressure ulcer at one stage and it progresses to a higher stage, you should report two separate codes, according to the ICD-10 guidelines. You should report L89.611 (Pressure ulcer of right heel, stage 1) for the site and stage of the ulcer on admission and L89.612 (Pressure ulcer of right heel, stage 2) for the same ulcer site and the highest stage reported during the stay.

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