ICD-10 Coding for Diabetic Ulcer(E11.621, L97.4-)
Complete ICD-10-CM coding and documentation guide for Diabetic Ulcer. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Diabetic Ulcer
E11.6Primary Range
Type 2 diabetes mellitus with specified complications
Primary range for diabetic ulcers, indicating diabetes with complications such as ulcers.
Non-pressure chronic ulcer of lower limb, not elsewhere classified
Describes the specific ulcer characteristics such as location and severity.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E11.621 | Type 2 diabetes mellitus with foot ulcer | Use when a patient with type 2 diabetes presents with a foot ulcer. |
|
| L97.4- | Non-pressure chronic ulcer of skin of lower limb, not elsewhere classified | Use to specify the site and severity of the ulcer in a diabetic patient. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for diabetic ulcer
Essential facts and insights about Diabetic Ulcer
Primary ICD-10-CM Codes for diabetic ulcer
Decision Criteria
clinical Criteria
- Presence of diabetes with a foot ulcer
Applicable To
- Diabetic foot ulcer
Excludes
- Pressure ulcer (L89.-)
Clinical Validation Requirements
- HbA1c >7%
- Monofilament test failure
Code-Specific Risks
- Misclassification with pressure ulcers
Coding Notes
- Ensure documentation specifies the ulcer as diabetic to avoid misclassification.
L97.4- - Non-pressure chronic ulcer of skin of lower limb, not elsewhere classified
Use to specify the site and severity of the ulcer in a diabetic patient.
Applicable To
- Chronic ulcer of skin of lower limb
Excludes
- Diabetic ulcers (E11.621)
Clinical Validation Requirements
- Ulcer depth and location documentation
Coding Notes
Ensure ulcer site and severity are documented accurately.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long term (current) use of insulin
Z79.4Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Pressure ulcer
L89.-Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Diabetic Ulcer to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.621.
Impact
Clinical: Inadequate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Use checklists for documentation, Regular training on documentation standards
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Ensure documentation specifies the ulcer type and location.
Impact
Incomplete documentation of ulcer characteristics can lead to audit issues.
Mitigation Strategy
Use detailed templates and regular audits of documentation practices.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Diabetic Ulcer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Diabetic Ulcer
Use these documentation templates to ensure complete and accurate documentation for Diabetic Ulcer. These templates include all required elements for proper coding and billing.
Diabetic foot ulcer management
Specialty: PodiatryRequired Elements
- Ulcer location and size
- Depth and severity
- Diabetes management
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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