ICD-10 Coding for Ulcer(K25.0, L89.210, L97.423)
Complete ICD-10-CM coding and documentation guide for Ulcer. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Ulcer
K25-K28Primary Range
Gastric, Duodenal, Peptic, and Gastrojejunal Ulcers
These codes cover various types of peptic ulcers with different complications.
Non-pressure Chronic Ulcers of Lower Limb
Codes for diabetic foot ulcers and other chronic ulcers of the lower limb.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K25.0 | Acute gastric ulcer with hemorrhage | Use when there is documented acute gastric ulcer with bleeding. |
|
| L89.210 | Pressure ulcer of right hip, unstageable | Use when a pressure ulcer is documented as unstageable due to eschar or slough. |
|
| L97.423 | Non-pressure chronic ulcer of right foot with necrosis of muscle | Use for chronic ulcers with documented muscle necrosis. |
|
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: How do you code a diabetic foot ulcer?
Essential facts and insights about Ulcer
Primary ICD-10-CM Codes for ulcer
Decision Criteria
clinical Criteria
- Documented acute gastric ulcer with bleeding
Applicable To
- Acute gastric ulcer with bleeding
Excludes
- Chronic gastric ulcer with hemorrhage (K25.4)
Clinical Validation Requirements
- Endoscopy report showing active bleeding
Code-Specific Risks
- Misclassification if chronic ulcer is present
Coding Notes
- Ensure documentation specifies acute nature and presence of hemorrhage.
L89.210 - Pressure ulcer of right hip, unstageable
Use when a pressure ulcer is documented as unstageable due to eschar or slough.
Applicable To
- Unstageable pressure ulcer of right hip
Excludes
- Pressure ulcer of right hip, stage 1-4 (L89.211-L89.214)
Clinical Validation Requirements
- Wound photography documenting unstageable ulcer
Coding Notes
Ensure documentation specifies unstageable status.
L97.423 - Non-pressure chronic ulcer of right foot with necrosis of muscle
Use for chronic ulcers with documented muscle necrosis.
Applicable To
- Diabetic foot ulcer with muscle necrosis
Excludes
- Pressure ulcer of right foot (L89.5-)
Clinical Validation Requirements
- MRI/CT showing muscle necrosis
Coding Notes
Ensure documentation includes ulcer location, laterality, and depth.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Type 2 diabetes mellitus with foot ulcer
E11.621Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Ulcer to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K25.0.
Impact
Clinical: Leads to inappropriate treatment plans., Regulatory: Fails to meet coding standards., Financial: Results in claim denials or reduced reimbursement.
Mitigation Strategy
Use detailed wound assessment forms., Train staff on importance of staging documentation.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Use T81.3- for surgical wound dehiscence.
Impact
Reimbursement: Claims may be denied for lack of specificity., Compliance: Fails to meet documentation standards., Data Quality: Leads to inaccurate clinical data.
Mitigation Strategy
Ensure documentation specifies foot involvement.
Impact
Inaccurate staging can lead to audits.
Mitigation Strategy
Implement regular training on staging criteria.
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 Ulcer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Ulcer
Use these documentation templates to ensure complete and accurate documentation for Ulcer. These templates include all required elements for proper coding and billing.
Diabetic Foot Ulcer Documentation
Specialty: EndocrinologyRequired Elements
- Ulcer location
- Laterality
- Depth
- Wagner grade
- ABPI
- HbA1c
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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