Podiatry Coding & Billing Alert

Question: A patient presented with a foot wound which has turned ulcerous. The patient had returned for reassessment and the area is now broken down with macerated tissue, with some spots of necrosis that require debridement and wound care. This is carried out utilizing a forceps and scalpel thru the dermal layer and dressed with a topical antibiotic and DSD. The patient is placed on crutches to remove all pressure from the area and will be seen back in 3 days. However, there is no artherosclerosis. What are the diagnosis coding options?

Kentucky Subscriber

Answer: Did the patient have a blister? “Shoe friction creating a large blister could turn into an ulcer, especially if the patient is diabetic or has poor circulation,” Arnold Beresh, DPM, CPC, CSFAC, of Dr. Arnold Beresh, PLC of Newport News, VA. points out. If the documentation indicates service rendered includes treatment of the blister as part of the wound care; your ICD-10 coding options include:

• S90.82 — Blister (nonthermal) of foot
• S90.822 — …, left foot
• S90.822S — …, left foot, sequela
• S90.822A — …, left foot, initial encounter
• S90.822D — …, left foot, subsequent encounter
• S90.821 — …, right foot
• S90.821S — …, right foot, sequela
• S90.821A — …, right foot, initial encounter
• S90.821D — …, right foot, subsequent encounter
• S90.829 — …, unspecified foot
• S90.829S — …, unspecified foot, sequela
• S90.829A — …, unspecified foot, initial encounter
• S90.829D — …, unspecified foot, subsequent encounter

For a diabetic patient, you need to add E08 (Diabetes mellitus due to underlying condition), E10 (Type 1 diabetes mellitus) or E11 (Type 2 diabetes mellitus) to indicate the underlying cause.

You have numerous coding options for non-pressure chronic ulcer beginning with L97.409 (Non-pressure chronic ulcer of unspecified heel and midfoot with unspecified severity). They are:

• L97.401 — Non-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin
• L97.402 — … with fat layer exposed
• L97.403 — … with necrosis of muscle
• L97.404 — … with necrosis of bone
• L97.411 — … right heel and midfoot limited to breakdown of skin
• L97.412 — … right heel and midfoot with fat layer exposed
• L97.413 — … right heel and midfoot with necrosis of muscle
• L97.414 — … right heel and midfoot with necrosis of bone
• L97.419 — … right heel and midfoot with unspecified severity
• L97.421 — … left heel and midfoot limited to breakdown of skin
• L97.422 — … left heel and midfoot with fat layer exposed
• L97.423 — … left heel and midfoot with necrosis of muscle
• L97.424 — … left heel and midfoot with necrosis of bone
• L97.429 — … left heel and midfoot with unspecified severity

Note: You will also need to add the relevant wound care code 97602 (Removal of devitalized tissue from wound[s], non-selective debridement, without anesthesia [e.g., wet-to-moist dressings, enzymatic, abrasion], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session).