Radiology Coding Alert

Laterality is the key to the right code.

When reporting varicose veins in ICD-10, you have options with fifth and sixth character of the codes which make the codes far specific than the ICD-9 options.

When your radiologist diagnoses varicose veins with ulcers, under ICD-9 you report 454.0 (Varicose veins of lower extremities with ulcer). “ICD-9 code 454.0 is currently used to describe varicose veins with ulcer of any part of the lower extremities and does not distinguish laterality,” says Christy Hembree, CPC, Team Leader, Summit Radiology Services, Cartersville, GA.

Once ICD-10 is implemented, you’ll need to pay closer attention to the documentation, because your code choices will be based on more exact anatomic sites.

The ICD-10 options include:

• I83.009 -- Varicose veins of unspecified lower extremity with ulcer of unspecified site
  
• I83.019 -- Varicose veins of right lower extremity with ulcer of unspecified site
  
• I83.029 -- Varicose veins of left lower extremity with ulcer of unspecified site.
  

“Although, you may still report varicose veins with ulcer without identifying the laterality by the use of I83.009 in ICD-10, you now have the option to be somewhat more specific simply by identifying the laterality. Code 183.019 is used to identify the right extremity and

183.029 is used to identify the left extremity. These codes are appropriate when the site of the ulcer is unknown,” says Hembree.

Explanation: In essence, you pay attention to the fifth and sixth character in the code. “The fifth character will indicate which extremity (if specified) is involved, and the sixth character will specify the site of the ulcer on that extremity,” says Hembree. Also, you will need to use a code from the L97.—series to identify the severity of the ulcer. For instance, if the ulcer is on the right thigh and limited to breakdown of the skin, you would report L97.111 (Non-pressure chronic ulcer of right thigh limited to breakdown of skin) as a secondary diagnosis. “ICD-10 instructs you to use additional codes to identify the severity of the ulcer when reporting varicose veins with ulcers. This code is to be used for non-pressure chronic ulcer of right thigh limited to breakdown of skin,” says Hembree.

Other details: The correct diagnosis might change, depending on how many details your provider includes in her documentation. For example, if she specifies varicose veins in the left leg with ulcer and inflammation, you’ll choose I83.229 (Varicose veins of left lower extremity with both ulcer of unspecified site and inflammation). “Code 183.229 is used to identify varicose veins in the left lower extremity when the patient has an ulcer and inflammation but the sites are unknown,” says Hembree.