We use ICD-10 codes that start with L97- for non-pressure chronic ulcers of the lower limb. We use these codes for diabetic foot ulcers, stasis ulcers and others. Since the onset of ICD-10, we have only had five sixth-character options for these codes. These are:
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 sixth-character options did not leave us the option to indicate with our coding that an ulcer had muscle exposed without necrosis of muscle or bone exposed without necrosis of bone. Thankfully, this situation has been remedied with the introduction of new sixth character options that we can use with all L97- codes. These go into effect October 1, 2017.
None of the above sixth characters are being deleted. The following sixth 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 not elsewhere classified (NEC)
The new sixth characters of “5” and “6” now give us the option to indicate the ulcer is to the depth of muscle or bone without necrosis at that depth. Use the new sixth character of “8” if the severity of the ulcer is specified in the documentation but none of the sixth character options of 1–6 are appropriate.
One can use these new sixth characters with any code that begins with L97-.
Note: Any ICD-10 code listed in this DPM Blog that ends with a “-” is not complete and requires more characters to complete the code.
Dr. Lehrman is on the APMA Coding Committee, serves as an expert panelist on Codingline and is a Fellow of the American Academy of Podiatric Practice Management (AAPPM). Follow him on Twitter @DrLehrman