Skin Ulcer Types
Pressure ulcers are also known as Decubitus Ulcers or Bedsores. These are localized injuries to the skin or underlying tissue that usually occur over a bony structure as a result of pressure, or pressure in combination with shear or friction. The most common sites are the skin over the sacrum, coccyx, heels or the hips. Other sites such as the elbows, knees, ankles or the back of the cranium can also be affected. These ulcers are localized injuries affecting the skin and underlying tissues, trauma associated with pressure and also friction, immobility, poor nutrition, hard surfaces and existing scars.
Pressure ulcers are classified as:
- Stage I
- Stage II
- Stage III
- Stage IV
- Unstageable
- Suspected deep tissue injury
ICD-10-CM category L89 codes classify pressure ulcers, which also include bed sores, pressure sores, decubitus ulcers, plaster ulcer and pressure area. According to the ICD-10-CM Guidelines, if any associated gangrene (I96) is documented, then that should be coded first.
There are four stages classified for pressure ulcer In ICD-10-CM . Also available are codes to classify unstageable pressure ulcers. Pressure ulcers may be unstageable due to the following reasons:
- The examination of the ulcer cannot be done at a particular time ? i.e., it is under a dressing or not debrided ;
- The eschar or blister covers the ulcer and the best practice is to let healing take place until the skin breaks down;
- The ulcer is an injury in evolution, for which the extent of injury is unclear until the dead tissue limits of.
Non-Pressure Skin Ulcers:
Category L97 codes classify non-pressure chronic ulcers of the lower limb. It includes the following according to the ICD-10-CM Guidelines:
- 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.
If no underlying condition is documented as the cause of the ulcer, a code from category L97 may be used as a principal or first listed code.
If one of the underlying conditions listed below is documented with a lower extremity non-pressure ulcer, then one of these should be coded first:
- Diabetic ulcers( E08.621,E08.622, E09.621, E09.622, E10.621, E10.622, E11.621, E11.622, E13.621, E13.622)
- Postphlebitic syndrome ( I87.01 -. I87.03-)
- Postthrombotic syndrome ( I87.01 – , I87.03 -)
- Varicose ulcer ( I83.0 – , I83.2 -)
- Any associated gangrene. ( I96)
- Atherosclerosis of 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 – )
Because ICD-10-CM codes are expansive compared to ICD-9-CM codes, coding skin and subcutaneous tissue will be challenging. Detailed information and specificity in documentation are the key factors in successfully coding ICD-10-CM skin and subcutaneous tissue.