Wiki Coding soft tissue radionecrosis as late effect of radiation treatment

[Rita Bartholomew]

Going in circles trying to determine correct codes for a chronic ulcer RLL, fat exposed, with underlying radiation necrosis of soft tissue from radiation treatment 4 years ago for squamous cell carcinoma.

L59.8 and Y84.2 ???
T66.xxxS and L59.8 ???

Gave up on 3M encoder which always brings me to gangrene. Wound care doc states that wouldn't be accurate as you could treat the gangrene but still have the radionecrosis underneath.

Help!

 

[thomas7331]

The Medicare NCD for HBO coverage of late effects of radiation cross-walked the old ICD-9 code 909.2 to L59.9. I don't think this is really correct and the L59.8 is the best because you do have a specified condition. The T66 radiation sickness code is not correct because of the 'excludes 1' note for the L55-L59 range. Unfortunately, if you are billing for HBO for this patient, you'd have to choose between using the L59.9 which isn't quite right vs. billing L59.8 and appealing your denials until they update the NCD.

 

[mitchellde]

If I am reading this correct you have a non pressure ulcer as a result of the chronic radiation dermatitis which has progressed to the fat layer and has necrosis? So why not use an L97 code with the W88 code using the 7th character S? If this is a correct interpretation.

 

[Rita Bartholomew]

soft tissue radionecrosis

Policies from other commercial carriers (i.e., Aetna, Anthem, Harvard Pilgrim) list T66.xxx+ as the diagnosis to use for soft tissue radionecrosis rather than W88. However, as Thomas mentioned in his response, the excludes 1 notes under T66 specifically tell us to use codes from the L55-L59 series instead, yet the NCD from CMS cross-referenced to the wrong ICD-10 dx code of L59.9 instead of L59.8 ("other specified disorders of the skin and subcutaneous tissue related to radiation") which is more appropriate.

We've opted to code it with L59.8 and appeal the denials.