ICD-10 Coding for Diabetic Ulcer Right Foot(E11.621, L97.413)
Complete ICD-10-CM coding and documentation guide for Diabetic Ulcer Right Foot. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Diabetic Ulcer Right Foot
E11.6-E11.69Primary Range
Type 2 diabetes mellitus with complications
Primary range for diabetes-related complications, including foot ulcers.
Non-pressure chronic ulcer of lower limb, not elsewhere classified
Used to specify the location and severity of the ulcer on the 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 when documenting a foot ulcer in a patient with Type 2 diabetes. |
|
| L97.413 | Non-pressure chronic ulcer of right midfoot with necrosis of muscle | Use when the ulcer involves muscle necrosis on the right 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: How do you code a diabetic ulcer on the right foot?
Essential facts and insights about Diabetic Ulcer Right Foot
Primary ICD-10-CM Codes for diabetic ulcer right foot
Decision Criteria
clinical Criteria
- Presence of a foot ulcer in a diabetic patient
Applicable To
- Diabetic foot ulcer
Excludes
- Pressure ulcer of foot
Clinical Validation Requirements
- HbA1c >7%
- Documented neuropathy
- Ulceration on foot
Code-Specific Risks
- Ensure ulcer is linked to diabetes
- Avoid unspecified ulcer codes
Coding Notes
- Ensure to document the ulcer's specific location and severity.
L97.413 - Non-pressure chronic ulcer of right midfoot with necrosis of muscle
Use when the ulcer involves muscle necrosis on the right midfoot.
Applicable To
- Ulcer with muscle necrosis
Excludes
- Ulcer with bone necrosis
Clinical Validation Requirements
- MRI showing muscle necrosis
- Positive probe-to-bone test
Coding Notes
Document the specific tissue layer involved in the ulcer.
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.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Diabetic Ulcer Right 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: Misrepresents patient's condition, Regulatory: Non-compliance with coding guidelines, Financial: Potential for claim denials
Mitigation Strategy
Always document the causal relationship, Use 'due to' or 'with' in notes
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit failures., Data Quality: Reduces accuracy of health records.
Mitigation Strategy
Specify the exact location and severity of the ulcer.
Impact
Using unspecified codes increases audit risk.
Mitigation Strategy
Ensure detailed documentation of ulcer characteristics.
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 Right Foot, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Diabetic Ulcer Right Foot
Use these documentation templates to ensure complete and accurate documentation for Diabetic Ulcer Right Foot. These templates include all required elements for proper coding and billing.
Diabetic ulcer with muscle necrosis
Specialty: PodiatryRequired Elements
- Ulcer location
- Size and depth
- Tissue involvement
- Diabetes control
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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