(Appropriate Coding of Ulcers continued) l 8 9 0 1 1 Category laterality stage • Varicose veins of the right lower extremity with both ulcer and inflammation on the calf, I83.212 • severity: nonpressure chronic ulcer of right lower calf with fat layer exposed, l97.222 DIABETIC OR NEUROTROPIC ULCERS Diabetic or neurotropic ulcers are foot ulcers that are open sores or wounds on the feet that do not completely heal or return after initial healing. These ulcers typically occur as a result of advancing diabetes and affect weight-bearing points on the bottom of the foot. The provider must document whether the patient has type 1 or type 2 diabetes and indicate the laterality of the ulcer, as well as the location. Figure 3 shows an example of the documentation and coding for a neurotrophic ulcer: • Type 2 diabetes mellitus with chronic right foot ulcer on the midfoot and heel with breakdown of the skin OWNER’S & MANAGER’S SUMMER CONFERENCE 38 HBma BIllINg • maY. juNe.2014 • Type 2 diabetes mellitus with right foot ulcer, e11.621 • Nonpressure, chronic ulcer right midfoot and heel with breakdown of the skin, l97.411 Patients at risk for neurotrophic ulcers include those with a history of numbness, paresthesia, or loss of sensation in the foot. ISCHEMIC OR ARTERIAL ULCERS Ischemic or arterial ulcers are due to poor circulation. The typical primary diagnosis is peripheral arterial disease, commonly referred to as PaD. The occurrence of an arterial ulcer is a risk factor of PaD. The provider must document atherosclerosis of native arteries, including laterality, and indicate the location and severity of the ulcer. an arterial ulcer can be coded as: • atherosclerosis of native arteries of left ankle with ulceration, I70.243 • Nonpressure, chronic ulcer of left ankle with necrosis of muscle, l97.303 Patients at risk for arterial ulcers include those with a history of smoking and intermittent claudication. Typical descriptors for the skin status include the following: • shear – stretching of the tissues when a patient’s body is moved up in bed • slough – dead tissue that separates from living tissue, often yellow in color • eschar – black tissue that often forms a hard shell over an ulcer Patients and caregivers can use a variety of preventive measures to avoid ulcers. still, ulcers occur in many patients. While physicians and their clinical teams can assist patients in developing the best strategy to meet their needs, medical coders can ensure patients’ records are being coded appropriately during the future transition to ICD-10. Valerie Fernandez is an AHIMA certified trainer for ICD-10 CM and ICD-10 PCS and participates in its Ambassador program for ICD-10. Currently, she is the ICD-10 quality assurance manager for Special Surgery in New York. She also holds a CPC and CPCH from the American Academy of Professional Coders (AAPC). FIgURE 3 OWNER’S & MANAGER’S CONFERENCE OCTOBER 24-26, 2013 July 10-12, 2014 Thursday – Saturday Nashville, Tennessee REGISTER TODAY! www.hbma.org July 10-12, 2014 (Thur. - Sat.) Nashville, TN
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