February 3, 2012

Skin Ulcer Coding in ICD-10-CM

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ICD-10-CM category L89 codes classify pressure ulcers, also known as bed sores, pressure sores or decubitus ulcers. Pressure ulcers are wounds caused by unrelieved pressure on the skin. These ulcers are localized injuries affecting skin and underlying tissues, representing trauma associated with pressure and also friction, immobility, poor nutrition, hard surfaces and existing scars.

 

In ICD-10-CM there are codes available to classify the four stages of pressure ulcers. There are also codes available to classify unstageable pressure ulcers. The following are some reasons why pressure ulcers may be unstageable:

  • The ulcer cannot be examined at a particular time – i.e., it’s under a dressing or not debrided;
  • The ulcer is covered by an eschar or blister, and best practice is to let healing take place until the skin breaks down;
  • The ulcer is an injury in evolution, for which the eventual extent of injury is unclear until the dead tissue demarcates.

Non-Pressure Skin Ulcers

Category L97 codes classify non-pressure chronic ulcers of the lower limb, including:

  • Chronic ulcer of skin not otherwise specified (NOS)
  • Non-healing ulcer of skin
  • Non-infected sinus of skin
  • Trophic ulcer NOS
  • Tropical ulcer NOS
  • Ulcer of skin NOS.

A code from category L97 may be used as a principal or first listed code if no underlying condition is documented as the cause of the ulcer.

If one of the underlying conditions listed below is documented with a lower extremity ulcer, a causal condition should be assumed:

  • Atherosclerosis of the lower extremities

Chronic venous hypertension

  • Diabetic ulcers
  • Postphlebitic syndrome
  • Postthrombotic syndrome
  • Varicose ulcer
  • Any associated gangrene.

Source:

Jones, Lolita M. (2012). Chapter 12: Diseases of the skin and subcutaneous tissue (L00-L99). ICD-10-CM Core Concepts: A Chapter-by-Chapter Review of Coding Conventions and Challenges (pp. 12-12 thru 12-16). Fort Washington, Md.: Lolita M. Jones Consulting Services.

 


 

Exercises:

In order to prepare you for ICD-10-CM coding of skin ulcers, the following exercises have been created as educational tools.

A 2012 ICD-10-CM code book or an electronic file of the code book contents will be needed in order to use this coding manual. To access the 2012 ICD-10-CM code book electronic files, please go online to http://www.cms.gov/ICD10/11b14_2012_ICD10CM_and_GEMs.asp#TopOfPage .

Under the “Downloads” subheading, scroll down and download the folder titled “2012 Code Tables and Index [ZIP, 16.7MB] .” Once the folder is open you will find several files, and you will need the following files when completing these exercises:

“ICD10CM_2012_Full_Tabular.pdf” – this is the 2012 ICD-10-CM Tabular List of Diseases and Injuries.

“ICD10CM_2012_Full_DIndex.pdf” –  this is the 2012 ICD-10-CM Index to Diseases and Injuries.

 

Exercise 1: Using the ICD-10-CM tabular list, fill in the blank for each of the following definitions:

A stage _____ pressure ulcer is one in which there is full skin loss involving damage or necrosis of subcutaneous tissue.

A stage _____ pressure ulcer involves pre-ulcer skin changes limited to persistent focal edema.

A stage _____ pressure ulcer is one in which there is necrosis of soft tissue through to underlying muscle, tendon or bone.

A stage _____ pressure ulcer is one in which there is an abrasion, blister and partial skin loss involving epidermis and/or dermis.

 

Exercise 2: Using the ICD-10-CM index to diseases and tabular list, fill in the blanks. The first row has been completed as an example. (Do not code from this chart, it is to be used for educational purposes only).

 

ULCER SITE

UNSTAGEABLE

STAGE 1

STAGE 2

STAGE 3

STAGE 4

Buttock – right

L89.310

L89.311

 

L89.312

L89.313

L89.314

Contiguous site, left lower back and left buttock

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Elbow – left

 

 

 

 

 

 

 

 

 

 

Heel – right

 

 

 

 

 

 

Sacral region

 

 

 

 

 

 

 

 

 

 

Upper back – left

 

 

 

 

 

 

 

 

 

 

 

Exercise 3: Using the ICD-10-CM index to diseases and tabular list, fill in the blanks. The first row has been completed as an example. (Do not code from this chart, it is to be used for educational purposes only).

 

NON-PRESSURE

ULCER SITE

BREAKDOWN OF SKIN

FAT LAYER EXPOSED

NECROSIS OF MUSCLE

NECROSIS OF    BONE

Calf – right

L97.211

L97.212

L97.213

L97.214

Lower leg – right

 

 

 

 

Midfoot – left

 

 

 

 

Thigh – right

 

 

 

 

Toes – left second and third

 

 

 

 

 


 

ANSWER KEY

Exercise 1: Using the ICD-10-CM tabular list, fill in the blank for each of the following definitions:

A stage 3 pressure ulcer is one in which there is full skin loss involving damage or necrosis of subcutaneous tissue.

A stage 1 pressure ulcer involves pre-ulcer skin changes limited to persistent focal edema.

A stage 4 pressure ulcer is one in which there is necrosis of soft tissue through to underlying muscle, tendon, or bone.

A stage 2 pressure ulcer is one in which there is an abrasion, blister and partial skin loss involving epidermis and/or dermis

 

Exercise 2:  Using the ICD-10-CM index to diseases and tabular list, fill in the blanks. The first row has been completed as an example. (Do not code from this chart, it is to be used for educational purposes only).

 

ULCER SITE

UNSTAGEABLE

STAGE 1

STAGE 2

STAGE 3

STAGE 4

Buttock – right

L89.310

L89.311

 

L89.312

L89.313

L89.314

Contiguous site, left lower back and left buttock

 

L89.40

 

 

L89.41

 

 

L89.42

 

 

L89.43

 

 

L89.44

 

Elbow – left

L89.020

 

L89.021

 

L89.022

 

L89.023

 

L89.024

 

Heel – right

L89.610

 

L89.611

L89.612

L89.613

L89.614

Sacral region

L89.150

 

L89.151

 

L89.152

 

L89.153

 

L89.154

 

Upper back – left

L89.110

 

L89.111

 

L89.112

 

L89.113

 

L89.114

 

 

Exercise 3: Using the ICD-10-CM index to diseases and tabular list, fill in the blanks. The first row has been completed as an example. (Do not code from this chart, it is to be used for educational purposes only).

 

NON-PRESSURE

ULCER SITE

BREAKDOWN OF SKIN

FAT LAYER EXPOSED

NECROSIS OF MUSCLE

NECROSIS OF    BONE

Calf – right

L97.211

L97.212

L97.213

L97.214

Lower leg – right

L97.911

L97.912

L97.913

L97.914

Midfoot – left

L97.421

L97.422

L97.423

L97.424

Thigh – right

L97.111

L97.112

L97.113

L97.114

Toes – left second and third

L97.521

L97.522

L97.523

L97.524

 

 

Read 1777 times Updated on March 16, 2016
Lolita M. Jones, MSHS, RHIA, CCS

Lolita M. Jones, MSHS, RHIA, CCS has provided Product Consultant services to a warehousing and analytics start-up that developed and marketed decision support software, health outcomes services, and regulatory compliance toolsets. Her goal is to combine her medical coding expertise with data mining-pattern recognition, to help improve data accuracy and compliance in medical coding and reimbursement (i.e., ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, modifiers, DRGs, APCs, and eAPGs). Ms. Jones also provides remote and on-site training/consulting in her newly developed Healthcare Data Mining Clinic educational series. She is currently pursuing a Graduate Certificate in Healthcare Data Analytics from a top university. Ms. Jones is based in New York and can be reached at .