Basics about Pressure and Non-Pressure Ulcers ICD 10 codes

A Pressure ulcer is also known as a decubitis ulcer, pressure sore, or bedsore. It’s an open wound on your skin. Decubitis ulcers often occur on the skin covering bony areas. The most common places for a decubitis ulcer are your elbow, heels, hips, ankles, shoulders, back (trunk), and back of the head.

Symptoms of Pressure ulcers include pain in affected area, infection, skin discoloration. Their are different stages of pressure ulcers.

Pressure ulcers are categorized by how severe they are, from stage 1 (earliest signs of skin breakdown) to stage 4 (deep breakdown of skin structures), as follows:

Stage 1:A reddened area on the skin that, when pressed, does not turn white. This indicates that a pressure ulcer is starting to develop.
Stage 2:The skin blisters or forms an open sore. The area around the sore may be red and irritated.
Stage 3:The skin breakdown now looks like a crater. The tissue below the skin has been damaged.
Stage 4:The pressure ulcer has become so deep that damage to the muscle and bone, and sometimes to tendons and joints, is evident.

In some cases, the patient may have associated gangrene. If gangrene is documented, code I96, Gangrene, not elsewhere classified, is coded first followed by the code for the pressure ulcer.

The affected area forms a blister, progresses to an open sore, and finally forms a crater that extends to the tissue below the skin.

Non-pressure chronic arterial ulcers result from an inadequate blood supply due to peripheral vascular disease, diabetes mellitus, trauma, or advanced age. They typically occur in the lower legs and feet.

Let us checkout more about skin and subcutaneous tissue diseases and the ICD 10 codes used with them.

Infections of the skin and subcutaneous tissue (L00-L08): Conditions may be localized, relatively uncomplicated, and easily treated. When the infectious agent has been identified, a secondary code ranging from B95 to B97 is assigned to identify the specific bacterial or viral agent involved for all codes in the range L00 to L08. These infections include abscesses, cellulitis, and lymphadenitis.

Bullous disorders (L10-L14): Bullae are blisters, small pockets of fluid within the upper layers of the skin. Bullous pemphigoid is an acute or chronic autoimmune skin disease. Instructions for drug-induced conditions specify to assign an additional code for the drug that caused the adverse effect. For code L14, Bullous disorders in diseases classified elsewhere there is a note to code first the underlying disease.

Dermatitis and eczema (L20-L30): A note is included in this code block that states that the terms dermatitis and eczema are used interchangeably. Eczema is a term for several different types of skin swelling. Most types cause red, swollen, and itchy skin. Factors that can cause eczema include other diseases, irritating substances, allergies, and genetic makeup. Instructions for drug-induced conditions in this code block specify to assign an additional code for the drug or substance that caused the adverse effect

Papulosquamous disorders (L40-L45): Papulosquamous disorders present with both papules and scales of the skin. Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery scales. These patches usually present on the elbows, knees, scalp, back, face, palms, and feet. Psoriasis is a problem with the immune system in which skin cells that grow deep in the skin rise to the surface too quickly. Instructions for drug-induced conditions in this code block specify to assign an additional code for the drug that caused the adverse effect. For code L45, Papulosquamous disorders in diseases classified elsewhere there is a note to code first the underlying disease.

Urticaria and erythema (L49-L54): Hives is a condition also referred to as urticaria. It is characterized by raised, often itchy, red welts on the surface of the skin. Erythema is a skin condition characterized by redness or rash. Code category L49, Exfoliation Due To Erythematous Conditions According to Extent of Body Surface involved has instructions to code first the erythematous condition that caused the exfoliation such as Ritter’s disease (L00). Code category L51, Erythema Multiforme has instructional notes stating to use an additional code to identify any associated manifestation such as conjunctivitis; to use an additional code for a drug that caused an adverse effect, if applicable; and to use an additional code to identify the percentage of skin exfoliation (L49-). When toxic erythema (L53.0) is caused by a poisoning due to a drug or toxin, an instructional notes states to code first the drug or toxin that caused the poisoning. If the toxic erythema is caused by an adverse effect of a drug an additional code is assigned for the drug that caused the adverse effect.

Radiation-related disorders of the skin and subcutaneous tissue (L55-L59) : This code block contains conditions such as sunburn and skin damage due to ultraviolet radiation. Instructional notes indicate that if the condition is caused by radiation, an additional code should be used to identify the source of the radiation; if the condition is due to an adverse effect of a drug, the drug causing an adverse effect is assigned as an additional code.

Disorders of skin appendages ( L60-L75): This code block contains nail disorders, baldness, and sweat gland disorders. There are instructional note for code category L62, Nail Disorders in Diseases Classified Elsewhere to code first the underlying disease, such as: pachydermoperiostosis (M89.4-). There are several codes in this category that have instructional notes stating that if the condition is due to an adverse effect of a drug, a code for the drug causing the condition is assigned as an additional code

Intraoperative and postprocedural complications of skin and subcutaneous tissue (L76): The complications reported with this code block include hemorrhages and hematomas of the skin and accidental puncture and laceration of skin and subcutaneous tissue during a procedure. Code L76.8, Other intraoperative and postprocedural complications of skin and subcutaneous tissue instructs the coder to use additional code, if applicable, to further specify disorder.

Other disorders of the skin and subcutaneous tissue (L80-L99): This code block includes birthmarks, other skin pigment problems, non-pressure, and pressure ulcers. Code category L86, Keratoderma in Diseases Classified Elsewhere and L99, Other disorders of skin and subcutaneous tissue in diseases classified elsewhere instructs the coder to code first any underlying disease. Code categories L89, Pressure Ulcer and L97, Non-Pressure Chronic Ulcer of Lower Limb, Not Elsewhere classified have an instructional note stating to code first any associated gangrene.

References:

https://www.aapc.com/blog/40338-pressure-ulcer

http://blr.hcpro.com/content

https://provider.healthalliance.org/coding-counts-post/