ICD-10 Coding for Diabetic Foot(E11.621, L97.413)
Complete ICD-10-CM coding and documentation guide for Diabetic Foot. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Diabetic Foot
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 for patients with Type 2 diabetes presenting with a foot ulcer. |
|
| L97.413 | Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle | Use for ulcers with muscle necrosis on the right heel/midfoot. |
|
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 Diabetic Foot
Primary ICD-10-CM Codes for diabetic foot
Decision Criteria
clinical Criteria
- Presence of a foot ulcer in a patient with Type 2 diabetes.
Applicable To
- Diabetic foot ulcer
Excludes
- Pressure ulcer (L89.-)
Clinical Validation Requirements
- HbA1c >7%
- Wagner Grade ≥2 ulcer
Code-Specific Risks
- Ensure ulcer is linked to diabetes in documentation.
Coding Notes
- Sequence diabetes complication codes before ulcer site codes.
L97.413 - Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle
Use for ulcers with muscle necrosis on the right heel/midfoot.
Applicable To
- Chronic ulcer with muscle necrosis
Excludes
- Diabetic ulcers (E10-E14 with .621)
Clinical Validation Requirements
- MRI/XR showing muscle necrosis
- Wound measurement
Coding Notes
Document ulcer site, depth, and necrosis accurately.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Diabetic Foot to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.621.
Impact
Clinical: Incomplete treatment documentation., Regulatory: Non-compliance with coding guidelines., Financial: Potential reimbursement loss.
Mitigation Strategy
Always check for insulin use in diabetic patients.
Impact
Reimbursement: May result in lower reimbursement rates., Compliance: Increases risk of audit failures., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Specify ulcer site and depth using L97.- codes.
Impact
High denial rates for unspecified ulcer codes.
Mitigation Strategy
Use specific L97.- codes with detailed documentation.
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 Foot, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Diabetic Foot
Use these documentation templates to ensure complete and accurate documentation for Diabetic Foot. These templates include all required elements for proper coding and billing.
Diabetic foot ulcer with muscle necrosis
Specialty: PodiatryRequired Elements
- Ulcer location
- Ulcer depth
- Diabetes type
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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