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New ICD-10 Ulcer Codes You Need to Know

09/26/2017 11:39 AM | Anonymous

ICD-10 codes that start with L97- are used for non-pressure chronic ulcers of the lower limb. These codes are used for diabetic foot ulcers, stasis ulcers, and others. Since the onset of ICD-10, there were only five 6th character options for these L97- codes. These were:

1 – limited to breakdown of skin
2 – with fat layer exposed
3 – with necrosis of muscle
4 – with necrosis of bone
9 – with unspecified severity

These did not leave the option to indicate with our codes that an ulcer had muscle exposed without necrosis of muscle or bone exposed without necrosis of bone. The APWCA worked with the Alliance of Wound Care Stakeholders to write to the World Health Organization (WHO) and explain this gap in code options and request that more options be created that would allow us to code these scenarios accurately.

Our efforts have been recognized! The WHO has announced new 6th character options that can be used with all L97- codes. These go into effect October 1, 2017.

The following 6th character options are being added:

5 – with muscle involvement without evidence of necrosis
6 – with bone involvement without evidence of necrosis
8 – with specified severity NEC

These new 6th characters of “5” and “6” allow the option to indicate the ulcer is to the depth of muscle or bone without necrosis at that depth. The new 6th character of “8” should be used if the severity of the ulcer is specified in the documentation, but none of the 6th character options of 1-6 are appropriate.

These new 6th characters can be used with any code that begins with L97-.

Note: Any ICD-10 code listed above that ends with a “-“ is not complete and requires more characters to complete the code.

Nothing discussed in this communication guarantees coverage or payment. The existence of an ICD-10 code does not ensure payment if it used. Coverage and payment policies of governmental and private payers may vary from time to time and in different parts of the country. Questions regarding coverage and payment by a payer should be directed to that payer. APWCA does not claim responsibility for any consequences or liability attributable to the use of any of the codes discussed in this communication.

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