Pressure Ulcers and Non-Pressure Ulcers
Codes for pressure ulcers and non-pressure ulcers (chronic) are located in ICD-10-CM chapter 12, Disease of the skin and subcutaneous tissue. The concept of laterality (e.g., left or right) is introduced, and should be included in the clinical documentation for skin ulcers.
ICD-10-CM codes for Pressure ulcers, located in Category L89, are combination codes that identify the site, stage, and (in most cases) the laterality of the ulcer. Possible stages are 1-4 and unstageable.
- Stage 1: Skin changes limited to persistent focal edema
- Stage 2: An abrasion, blister, and partial thickness skin loss involving the dermis and epidermis
- Stage 3: Full thickness skin loss involving damage and necrosis of subcutaneous tissue
- Stage 4: Necrosis of soft tissues through the underlying muscle, tendon, or bone
- Unstageable: Based on clinical documentation the stage cannot be determined clinically (Eg: The wound is covered with eschar) or for ulcers documented as deep tissue injury without evidence of trauma.
An instructional note in ICD-10 instructs us to code also any associated gangrene (I96).
Non-pressure chronic ulcers are similar to pressure ulcers in that they require documentation of the site, severity, and laterality. Category L97 and L98 are for Non-pressure ulcers, and have an instructional note to code first any associated underlying condition, such as:
- Associated gangrene.
- Atherosclerosis of the lower extremities.
- Chronic venous hypertension.
- Diabetic ulcers.
- Postphlebetic syndrome.
- Postthrombotic syndrome.
- Varicose ulcers.
The severity of the ulcers is described as:
- Limited to breakdown of skin.
- With fat layer exposed.
- With necrosis of muscle.
- With necrosis of bone.