ICD-10 Coding for Diabetic wounds, what you as a podiatrist should know.

We are now a 2 full months into the ICD-10 code take over.  In my own practice, I can tell you that my world did not come crumbling down, and claims from all payers are coming in the normal standard fashion.  All of my at risk foot care or diabetic foot care claims have all been clean with no problems. Normal every day tendon injuries like peroneal tendonitis, Achilles tendonitis, posterior tibial tendonitis and plantar fasciitis claims are going through as well with no problems.

The only claims that I had kicked back to me have been my diabetic foot ulcers.  The following is what you need to know to bill a diabetic foot wound correctly:

1.  You will need the diabetic foot code associated with if the person is Type 1 or Type 2 diabetic and has a foot wound

• E11.621- Type 2 diabetes with foot ulcer
• E10.621- Type 1 diabetes with foot ulcer

2.  You will need the code for the specificity of the site, laterality, and depth.  L97.5 is a non pressure wound other part of the foot(toes) and L97.4 is a non pressure wound on the heel or midfoot adding a 1 or 2 gives the laterality, right or left foot respectively. But the addition of depth is included in the codes below to give you the most specificity for these codes to be covered and paid. 

If your wound is on the right side you will be using one of the codes below for a diabetic foot wound on the toes:

• L97.511-  Right foot non pressure ulcer with breakdown of skin
• L97.512-  Right foot non pressure ulcer with fat layer exposed
• L97.513-  Right foot non pressure ulcer with necrosis of muscle
• L97.514-  Right foot non pressure ulcer with necrosis of bone

If your wound is on the left side you will be using one of the codes below for a diabetic foot wound on the toes:

• L97.521-  Left foot non pressure ulcer with breakdown of skin
• L97.522-  Left foot non pressure ulcer with fat layer exposed
• L97.523-  Left foot non pressure ulcer with necrosis of muscle
• L97.524-  Left foot non pressure ulcer with necrosis of bone

If your wound is on the right side you will be using one of the codes below for a diabetic foot wound on the heel or midfoot:

• L97.411-  Right foot non pressure ulcer with breakdown of skin
• L97.412-  Right foot non pressure ulcer with fat layer exposed
• L97.413-  Right foot non pressure ulcer with necrosis of muscle
• L97.414-  Right foot non pressure ulcer with necrosis of bone

If your wound is on the left side you will be using one of the codes below for a diabetic foot wound on the heel or midfoot:

• L97.421-  Left foot non pressure ulcer with breakdown of skin
• L97.422-  Left foot non pressure ulcer with fat layer exposed
• L97.423-  Left foot non pressure ulcer with necrosis of muscle
• L97.424-  Left foot non pressure ulcer with necrosis of bone

3.  Most of our diabetic patients that have foot ulcers also have some degree of polyneuropathy and coding for that would get you to the highest level of specificity using one of the following codes linking the Type 1 or 2 diabetes with the polyneuropathy:

• E11.42- Type 2 diabetes with diabetic polyneuropathy

• E10.42- Type 1 diabetes with diabetic polyneuropathy

For example, from the information above, if you had a Type 2 diabetic with a foot ulcer on their left heel with exposed bone and they have polyneuropathy the only three codes you need to be reimbursed with the correct documentation, would be the following:

• E11.621
• L97.424
• E11.42

This again is pretty simple when you have it all in front of you and organized, As it is almost impossible to have all of these codes on your superbill or encounter form, it may be a great idea to have these codes on a cheat sheet in each treatment room.  It will save you time, not having to scroll through your EMR for the codes, especially of you see high volume of diabetic wounds. 

I hope this helps makes your life a little easier in the ICD-10 new world of billing. I know in my practice I see a lot of diabetic wounds so I was happy to see these codes were not terribly convoluted. If you do not have a "superbill" we have a quick reference sheet, for what we see as podiatrist most common diagnosis, available at our website. For $75 we will email it to you with our metatarsal fracture cheat sheet and our power point on billing diabetic foot care. Our website is listed here   http://centeranklefootcare.com/catalog/c14_p1.html
this is an editable rtf and pdf format.

Good luck with your billing!

Michele McGowan, DPM