ICD-10 Coding for Ulcer Foot(L97.411, E11.621)
Complete ICD-10-CM coding and documentation guide for Ulcer Foot. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Ulcer Foot
L97.40-L97.52Primary Range
Non-pressure chronic ulcer of lower limb, not elsewhere classified
This range includes codes for non-pressure ulcers of the foot, specifying location and severity.
Type 1 and Type 2 diabetes mellitus with foot ulcer
These codes specify diabetes with foot ulcer, which is crucial for sequencing in diabetic patients.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| L97.411 | Non-pressure chronic ulcer of right heel and midfoot limited to breakdown of skin | Use when documenting a non-pressure ulcer on the right heel or midfoot with skin breakdown. |
|
| E11.621 | Type 2 diabetes mellitus with foot ulcer | Use for patients with Type 2 diabetes presenting with a foot ulcer. |
|
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 Foot
Primary ICD-10-CM Codes for ulcer foot
Decision Criteria
documentation Criteria
- Document ulcer location, laterality, and depth.
Applicable To
- Ulcer of heel
- Ulcer of midfoot
Excludes
- Pressure ulcer of heel
- Ulcer due to diabetes
Clinical Validation Requirements
- Documentation of ulcer location and depth
- Assessment of necrosis or infection
Code-Specific Risks
- Risk of unspecified location leading to claim denials
Coding Notes
- Ensure documentation specifies laterality and depth for accurate coding.
E11.621 - Type 2 diabetes mellitus with foot ulcer
Use for patients with Type 2 diabetes presenting with a foot ulcer.
Applicable To
- Diabetic foot ulcer
Excludes
- Ulcer due to other causes
Clinical Validation Requirements
- HbA1c >7%
- Documentation of diabetic foot ulcer
Coding Notes
Ensure diabetes is documented as the underlying cause of the ulcer.
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 Ulcer Foot to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code L97.411.
Impact
Clinical: Inaccurate patient records., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Implement checklist for ulcer documentation., Regular training sessions for clinical staff.
Impact
Reimbursement: Unspecified codes may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Poor data quality affecting patient records.
Mitigation Strategy
Specify laterality and depth to use more specific codes.
Impact
High risk of audit for using unspecified codes like L97.40.
Mitigation Strategy
Use specific 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 Ulcer Foot, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Ulcer Foot
Use these documentation templates to ensure complete and accurate documentation for Ulcer Foot. These templates include all required elements for proper coding and billing.
Diabetic foot ulcer with necrosis
Specialty: EndocrinologyRequired Elements
- Ulcer location and size
- Depth and presence of necrosis
- Diabetes management details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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