General Surgery Coding Alert

You won't need an additional code for 'stage.'

When you report a pressure (decubitus) ulcer diagnosis under ICD-9, you have to use two codes -- one to report the location, and one to report the stage. All that changes when ICD-10 goes into effect.

Although the number of codes explodes from 14 under ICD-9 to over 150 in ICD-10, you'll just need one code to report the pressure ulcer location and stage when you begin reporting using the new diagnosis code set.

Identify Pressure Ulcer Site

With ICD-9, you have nine "location" codes to choose from, as follows:

• 707.00 -- Pressure ulcer; unspecified site
• 707.01 -- ... elbow
• 707.02 -- ... upper back
• 707.03 -- ... lower back
• 707.04 -- ... hip
• 707.05 -- ... buttock
• 707.06 -- ... ankle
• 707.07 -- ... heel
• 707.09 -- ... other site.

ICD-10 provides much greater site specificity, creating many more code options, as follows:

• L89.9_ -- Pressure ulcer of unspecified site
• L89.00_ -- Pressure ulcer of unspecified elbow
• L89.01_ -- Pressure ulcer of right elbow
• L89.02_ -- Pressure ulcer of left elbow
• L89.10_ -- Pressure ulcer of unspecified part of back
• L89.11_ -- Pressure ulcer of right upper back
• L89.12_ -- Pressure ulcer of left upper back
• L89.13_ -- Pressure ulcer of right lower back
• L89.14_ -- Pressure ulcer of left lower back
• L89.15_ -- Pressure ulcer of sacral region
• L89.20_ -- Pressure ulcer of unspecified hip
• L89.21_ -- Pressure ulcer of right hip
• L89.22_ -- Pressure ulcer of left hip
• L89.30_ -- Pressure ulcer of unspecified buttock
• L89.31_ -- Pressure ulcer of right buttock
• L89.32_ -- Pressure ulcer of left buttock
• L89.4_ -- Pressure ulcer of contiguous site of back, buttock and hip
• L89.50_ -- Pressure ulcer of unspecified ankle
• L89.51_ -- Pressure ulcer of right ankle
• L89.52_ -- Pressure ulcer of left ankle
• L89.60_ -- Pressure ulcer of unspecified heel
• L89.61_ -- Pressure ulcer of right heel
• L89.62_ -- Pressure ulcer of left heel
• L89.81_ -- Pressure ulcer of head
• L89.89_ -- Pressure ulcer of other site.

Report Pressure Ulcer Stage

Following pressure-ulcer site code 707.0x, ICD-9 instructs coders, "Use additional code to identify pressure ulcer stage (707.20-707.25)."

The "stage" codes provide the following diagnostic information:

• 707.21 -- Pressure ulcer, stage I. This stage involves intact skin with redness of a localized area, usually over a bony prominence
• 707.22 -- Pressure ulcer, stage II. Stage II ulcers may have intact or ruptured serum-filled blisters and a partial-thickness loss of dermis.
• 707.23 -- Pressure ulcer, stage III. Full-thickness tissue loss is characteristic of this stage, possibly with subcutaneous fat visible.
• 707.24 -- Pressure ulcer, stage IV. Exposed bone, tendon or muscle from full-thickness tissue loss defines this stage.

ICD-10 recognizes the same four stages -- plus "unstageable" or "unspecified stage" pressure ulcers. But instead of using an additional code to capture the stage information, each of the site codes includes a final digit to account for these six "stage" choices.

For instance: L89.11_ expands to the following six codes:

• L89.110 -- Pressure ulcer of right upper back, unstageable
• L89.111 -- ... stage 1
• L89.112 -- ... stage 2
• L89.113 -- ... stage 3
• L89.114 -- ... stage 4
• L89.119 -- ... unspecified stage.