ICD-10 Coding for Ulcer Toe(L97.511, E11.621)
Complete ICD-10-CM coding and documentation guide for Ulcer Toe. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Ulcer Toe
L97.4-L97.5Primary 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 toe.
Diabetes mellitus with foot ulcer
These codes are used when the ulcer is a complication of diabetes mellitus.
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 the ulcer is limited to skin breakdown on the right toe. |
|
| E11.621 | Type 2 diabetes mellitus with foot ulcer | Use when the foot ulcer is a complication of type 2 diabetes. |
|
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 toe ulcer
Essential facts and insights about Ulcer Toe
Primary ICD-10-CM Codes for ulcer toe
Decision Criteria
clinical Criteria
- Ulcer limited to skin breakdown on the right toe
Applicable To
- Ulcer of right toe with skin breakdown
Excludes
- Pressure ulcer of right toe
Clinical Validation Requirements
- Documentation of ulcer location and skin breakdown
- Photographic evidence or clinical notes confirming skin breakdown
Code-Specific Risks
- Risk of using unspecified codes if laterality is not documented
Coding Notes
- Ensure laterality and depth are documented to avoid unspecified codes.
E11.621 - Type 2 diabetes mellitus with foot ulcer
Use when the foot ulcer is a complication of type 2 diabetes.
Applicable To
- Diabetic foot ulcer
Excludes
- Foot ulcer not due to diabetes
Clinical Validation Requirements
- HbA1c levels indicating diabetes
- Clinical notes linking ulcer to diabetic neuropathy
Coding Notes
Diabetes must be 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.
Long-term (current) use of insulin
Z79.4Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Ulcer 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: Inaccurate representation of patient's condition., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials or reduced reimbursement.
Mitigation Strategy
Link ulcer to diabetes in clinical notes, Use HbA1c levels to support diabetes diagnosis
Impact
Reimbursement: Unspecified codes may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Poor data quality and inaccurate clinical records.
Mitigation Strategy
Document laterality and depth to use specific codes like L97.511.
Impact
High risk of audits if unspecified codes are used frequently.
Mitigation Strategy
Document specific ulcer details to use precise 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 Toe, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Ulcer Toe
Use these documentation templates to ensure complete and accurate documentation for Ulcer Toe. These templates include all required elements for proper coding and billing.
Diabetic foot ulcer documentation
Specialty: PodiatryRequired Elements
- Ulcer location and size
- Depth and necrosis presence
- Underlying conditions like diabetes
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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