Outpatient Facility Coding Alert

Published on Thu Apr 24, 2014 PDF

You will need to list the underlying cause before you code for ulcer.

Diagnosis 707.9 (Chronic ulcer of unspecified site) in ICD-9-CM is a billable medical code for a chronic ulcer. The 30-year-old ICD- 9 system does not specify any site or type or severity, however, which means you report 707.9 for multiple situations.

Transition to ICD-10 system: The new system of coding for chronic ulcer provides a wide range of option to choose from which makes the billing process much more streamlined, efficient, and accurate.

Coding and documentation of chronic ulcers will be greatly expanded in ICD-10-CM. You will find the codes in the L97 (Non-pressure chronic ulcer of lower limb, not elsewhere classified) and L98 (Other disorders of skin and subcutaneous tissue, not elsewhere classified) categories. Life is much easier with the instructional notes provided, which shall help you to state the codes correctly. 

Example: Notes instruct you to list any associated underlying conditions before the code for chronic ulcer. Associated conditions can include those such as: 

i) Diabetic ulcers (E08.621, E08.622, E09.621, E09.622, E10.621, E10.622, E11.621,  E11.622, E13.621,E13.622)
ii) Any associated gangrene (I96)
iii) Atherosclerosis of the lower extremities(I70.23-, I70.24-, I70.33-, I70.34-, I70.43-, I70.44-, I70.53-, I70.54-, I70.63-, I70.64-, I70.73-, I70.74-)
iv) Varicose ulcer (I83.0-, I83.2-)
v) Chronic venous hypertension (I87.31-, I87.33-)
vi) post thrombotic syndrome (I87.01-, I87.03-)
vii) post phlebitic syndrome (I87.01-, I87.03-).

ICD-10 will make reporting ulcers precise by breaking down the codes based on severity and site. For example, you’ll have separate diagnoses for non-pressure ulcer to the right or left thigh, right or left calf, right or left ankle, and more. 

Resource: The following information sheet from AAPC can be used as a quick reference or as a tool for providers:  http://cloud.aapc.com/documents/Non-PressureChronicUlcers_ICD-10-CM.pdf. 

Coding tips: Before you can successfully code non-pressure ulcers with ICD-10, you’ll need details regarding anatomic location, laterality (when applicable), severity, and causation (as shown above). That means your providers will need to be very specific in their documentation so you can assign the most appropriate diagnosis.