ICD-10 Coding for Foot Ulceration(E11.621, L97.423)
Complete ICD-10-CM coding and documentation guide for Foot Ulceration. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Foot Ulceration
E11.6-E11.9Primary Range
Type 2 Diabetes Mellitus with complications
Primary range for diabetic foot ulcers, indicating diabetes with foot complications.
Non-pressure chronic ulcer of lower limb, not elsewhere classified
Used to specify the severity and location of the ulcer.
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. |
|
| L97.423 | Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle | Use when the ulcer involves necrosis of muscle tissue. |
|
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 foot ulcer
Essential facts and insights about Foot Ulceration
Primary ICD-10-CM Codes for foot ulceration
Decision Criteria
clinical Criteria
- Presence of a foot ulcer in a diabetic patient
Applicable To
- Diabetic foot ulcer
Excludes
- Pressure ulcer (L89.-)
Clinical Validation Requirements
- Documentation of diabetes with a foot ulcer
- Assessment of neuropathy or ischemia
Code-Specific Risks
- Incorrect sequencing with ulcer codes
- Missing documentation linking diabetes to the ulcer
Coding Notes
- Ensure diabetes is documented as the cause of the ulcer.
L97.423 - Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle
Use when the ulcer involves necrosis of muscle tissue.
Applicable To
- Ulcer with muscle necrosis
Excludes
- Ulcer with gangrene (I96)
Clinical Validation Requirements
- Documentation of ulcer depth reaching muscle
- Specific location and laterality
Coding Notes
Ensure documentation specifies depth and laterality.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of insulin
Z79.4Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Foot Ulceration to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.621.
Impact
Clinical: Misrepresents patient's condition., Regulatory: Non-compliance with coding guidelines., Financial: Potential for claim denials.
Mitigation Strategy
Use structured templates, Regular documentation audits
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Triggers audits for unspecified coding., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Ensure documentation specifies ulcer depth and location.
Impact
Using unspecified codes when details are available.
Mitigation Strategy
Enhance 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 Foot Ulceration, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Foot Ulceration
Use these documentation templates to ensure complete and accurate documentation for Foot Ulceration. These templates include all required elements for proper coding and billing.
Diabetic foot ulcer with muscle necrosis
Specialty: PodiatryRequired Elements
- Ulcer location and laterality
- Depth of ulcer
- Diabetes status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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