ICD-10 Coding for Ulcer on Toe(L97.511, E11.621)
Complete ICD-10-CM coding and documentation guide for Ulcer on Toe. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Ulcer on Toe
L97.5-L97.9Primary Range
Non-pressure chronic ulcer of lower limb, not elsewhere classified
This range includes codes for non-pressure ulcers of the lower limb, including the toes, which are common in diabetic patients.
Type 2 diabetes mellitus with specified complications
This range is used for coding diabetic complications, including foot ulcers.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| L97.511 | Non-pressure chronic ulcer of right toe limited to breakdown of skin | Use when there is a documented non-pressure ulcer on the right toe with skin breakdown. |
|
| E11.621 | Type 2 diabetes mellitus with foot ulcer | Use when a patient with type 2 diabetes has a documented 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 to code a diabetic toe ulcer
Essential facts and insights about Ulcer on Toe
Primary ICD-10-CM Codes for ulcer on toe
Decision Criteria
clinical Criteria
- Presence of non-pressure related ulcer on right toe
Applicable To
- Ulcer of right toe with skin breakdown
Excludes
- Pressure ulcer of right toe
Clinical Validation Requirements
- Documented skin breakdown on the right toe
- Absence of pressure-related causes
Code-Specific Risks
- Risk of using unspecified codes if laterality is not documented
Coding Notes
- Ensure documentation specifies laterality and depth of the ulcer.
E11.621 - Type 2 diabetes mellitus with foot ulcer
Use when a patient with type 2 diabetes has a documented foot ulcer.
Applicable To
- Diabetic foot ulcer
Excludes
- Foot ulcer without diabetes
Clinical Validation Requirements
- Diagnosis of type 2 diabetes
- Presence of a foot ulcer
Coding Notes
Sequence diabetes code first, followed by ulcer code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 on Toe to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code L97.511.
Impact
Clinical: Leads to inaccurate clinical records, Regulatory: Non-compliance with coding guidelines, Financial: Potential claim denials or reduced reimbursement
Mitigation Strategy
Always document the side of the body affected, Use templates that prompt for laterality
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Document laterality and specific location to use specific codes.
Impact
High risk of audit when unspecified codes are used for detailed conditions.
Mitigation Strategy
Ensure documentation is complete and specific to avoid using unspecified codes.
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 on Toe, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Ulcer on Toe
Use these documentation templates to ensure complete and accurate documentation for Ulcer on Toe. These templates include all required elements for proper coding and billing.
Diabetic patient with toe ulcer
Specialty: PodiatryRequired Elements
- Location and laterality of ulcer
- Depth and severity
- Presence of infection or gangrene
- Diabetes management details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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