Transcript InSite User Group

Ingenix InSite
Provider User Group
June 14, 2011
Approval Code: IN361
Ingenix InSite User Group: Welcome
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© Ingenix, Inc. 2
Ingenix InSite User Group: Agenda
 10:00 AM
Welcome
 10:03 AM
InSite Operations Announcements
 10:10 AM
CMS County Rate Methodology Change
 10:30 AM
Documentation and Coding Focus On:
Skin Ulcers
 10:55 AM
Q&A
© Ingenix, Inc. 3
InSite Operations Announcements –
UHG’s Health Services Re-Branding to Optum

Per 4/11/11 Ingenix press release, UnitedHealth Group announced “Optum”
master brand for its Health Services Businesses
–
OptumHealth™ will continue to be
–
Ingenix™ is now
–
Prescription Solutions™ is now

This brand unification is focused on making it easier for the broad health
services marketplace to understand and access the company’s full range of
capabilities that help participants throughout the health care system
improve health, increase efficiency and create a better overall experience for
consumers.

This change reflects increased coordination and collaboration among three
leading health services companies that are committed to addressing
meaningful and positive change across the health care system
InSite Operations Announcements
Presented By
Jerry Gauchat
InSite Operations Announcements –
Data Refresh Update
 Data Refresh Update
–
–
Data refreshed June 6th
Next monthly data refresh is scheduled for July 5th
InSite Operations Announcements –
Q2 2011 Release

Upcoming InSite Updates
–
New HEDIS/STARS PAF Versions
•
–
No changes to PAF Management functionality
Summary of Accepted HCCs (SOAH) Modifications
•
•
Modify query to access report more quickly
Upon export - HCC and description will match
–
Systematic User Entitlement
–
Changing default sort on Custom List to default to PCP Name
–
Learning & Resources Tab
•
•
•
•
•
•
Adding April, May & June 2011 Ingenix Insiders
Removing all 2010 Ingenix Insiders
Removing 2010 ICD-9 Brochure
Updating RAF Calculator to include updated FFS Normalization value
Updating Chart Mechanics for Data Validation document
Adding Understanding & Coding Medicare Preventive Services document
InSite Operations Announcements –
Q3 2011 Release (Sep/Oct 2011)

Planned* InSite Updates
–
Adding Rendering provider logic impacting
•
•
•
–
Adding new Health Plan Summary report
•
–
–
–
Population Report
PAF
CSI / Problem List
Prevalence by Plan PBP
Adding HCC RAF to Group & Provider Summary Report
Adding plan filters to Management Problem List and Custom List
Adding logic to the report list screen to allow for re-accessing without
logging out
*Planned – not confirmed
CMS County Rate Methodology
Changes
Presented By
Nick Chiechi
2012 Payment Year Changes
 Health Care Reform Bill (Affordable Care Act) Introduced
Changes Impacting Medicare Advantage CMS Payments
For 2012 and Beyond
 Changes Impact CMS Determination of County Rates and
Calculation of Rebates
– Changes Were Made to Methodology and/or Associated
Values Within Existing Methodologies
2012 County Rate Methodology
 CMS Introduced a New Methodology For Determining
County Rates
– New Methodology Will Be Phased in Over Two to Six Years
(Varies By County)
• New Methodology: “Specified Amount”
• Pre-2012 Methodology: “Applicable Amount”
– STARS Quality Bonus Prominently Impacts County Rates
• STARS Impacts Both New and Pre-2012 Methodologies
Transition Periods For New
Methodology
 2012 County Rate is Blend of “Applicable Amount” and
“Specified Amount”
– Plans <=2.5 Stars Capped at Pre-CA Value
 Applicable (old) and Specified (new) Amounts Are
Independently Calculated
 Blended Based on Transition Schedule
– Transition Schedule Will Vary By County
• Based on a One-Time CMS Calculation Using the 2010
Applicable Amount
Transition Schedule
Payment Two Year Transition Four Year Transition Six Year Transition
Year Applicable Specified Applicable Specified Applicable Specified
2012
50%
50%
75%
25%
83%
17%
2013
100%
50%
50%
67%
33%
2014
100%
25%
75%
50%
50%
2015
100%
100%
33%
67%
2016
100%
100%
17%
83%
2017
100%
100%
100%
Applicable Amount (Old Methodology)
Overview
 Greater of:
– 2012 FFS Rate
- OR -
– 2011 Applicable Amount Adjusted For 2012 National Per Capita MA
Growth Percentage
 Greater Amount Then Reduced For IME Phase-out
 New Twist For 2012 and Beyond
– Applicable Amount Will Also Be Adjusted For Each Contract’s STARS
Rating
Specified Amount (New Methodology)
Overview
 A Baseline Amount Is Calculated For Each County
– FFS Rate Minus IME Phase-out Amount
 For Each County, the Baseline Is Adjusted For the
Following:
– “Applicable Percentage”
• Based on Newly Designated Quartile
– STARS Quality Bonus Percentage
Specified Amount (New Methodology)
Applicable Percentage
 Baseline For Each County is Adjusted For A Applicable Percentage
Quartile
4th (Highest)
3rd
2nd
1st (Lowest)
Applicable Percentage
95%
100%
107.5%
115%
 Counties Were Ranked From Highest To Lowest Using Most Recent
Rebased FFS Costs
– For 2012, 2009 FFS Costs Were Used
STARS Quality Bonus Percentage
 Each Contract Achieves a STARS Rating
 Each Rating Translates To a Bonus Percentage To Be
Applied to Each County’s Calculated County Rate
 Bonus Is Applied to Both the Applicable Amount (Old
Methodology) and Specified Amount (New Methodology)
– Applied Slightly Differently To Specified Amount vs. Applicable
Amount
STARS Quality Bonus Percentage
STARS Rating
Less than 3 stars
3 stars
3.5 stars
4 stars
4.5 stars
5 stars
Quality Bonus Payment
Percentage
0%
3%
3.5%
4%
4%
5%
* Quality Bonus Percentages Will Be Doubled in “Qualifying” Counties
– Qualifying County Determined Using 2012 FFS Rate and Size and Penetration
of MA Population
Example
 Los Angeles County
– Quartile: 4
– Transition Period: 4 Years
– Qualifying County?: No
 ABC Health Plan
– STARS Rating: 3.5 Stars
Applicable Amount Calculation
Example
2012 FFS Rate
$853.34
Trended 2011 Applicable Amount
$959.98
Greater of Two Above Amounts
Quality Bonus Payment Percentage
Quality Adjusted Applicable Amount
$959.98
3.5%
$993.58
STARS Rating
Less than 3 stars
3 stars
3.5 stars
4 stars
4.5 stars
5 stars
Quality Bonus Payment
Percentage
0%
3%
3.5%
4%
4%
5%
Specified Amount Calculation
Example
2012 FFS Rate
$853.34
Applicable Percentage
Quality Bonus Payment Percentage
Quality Adjusted Applicable Percentage
95%
3.5%
98.5%
Quality Adjusted Specified Amount
County Specifc (Not Contract Dependent)
Quartile
Applicable Percentage
4th (Highest)
95%
3rd
100%
2nd
107.5%
1st (Lowest)
115%
$840.54
Contract Specific (Not County Specifc)
STARS Rating
Less than 3 stars
3 stars
3.5 stars
4 stars
4.5 stars
5 stars
Quality Bonus Payment
Percentage
0%
3%
3.5%
4%
4%
5%
Blended County Ratebook Calculation
Example
Quality Adjusted Amount
Applicable
$993.58
Specified
$840.54
2012 Blend %
Blend Amount
75%
$745.19
25%
$210.14
+
County Ratebook Amount
Payment
Year
2012
2013
2014
2015
2016
2017
Two Year Transition
Applicable Specified
50%
50%
100%
100%
100%
100%
100%
$955.33
Four Year Transition
Applicable Specified
75%
25%
50%
50%
25%
75%
100%
100%
100%
Six Year Transition
Applicable Specified
83%
17%
67%
33%
50%
50%
33%
67%
17%
83%
100%
Pro Forma Blending
Imperial County
2012
$727
$748
$752
$755
$755
$762
2013
$699
$718
$721
$724
$724
$731
2014
$699
$718
$721
$724
$724
$731
2015
$699
$718
$721
$724
$724
$731
2016
$699
$718
$721
$724
$724
$731
2017
$699
$718
$721
$724
$724
$731
Los Angeles County
2012
<=2.5 Stars
$923
3.0 Stars
$951
3.5 Stars
$955
4.0 Stars
$960
4.5 Stars
$960
5 Stars
$969
2013
$885
$913
$917
$922
$922
$931
2014
$848
$874
$879
$883
$883
$892
2015
$811
$836
$841
$845
$845
$853
2016
$811
$836
$841
$845
$845
$853
2017
$811
$836
$841
$845
$845
$853
2013
$811
$835
$840
$844
$844
$852
2014
$790
$814
$819
$823
$823
$831
2015
$770
$794
$797
$801
$801
$809
2016
$749
$773
$776
$780
$780
$788
2017
$729
$752
$755
$759
$759
$767
<=2.5 Stars
3.0 Stars
3.5 Stars
4.0 Stars
4.5 Stars
5 Stars
Monterey County
<=2.5 Stars
3.0 Stars
3.5 Stars
4.0 Stars
4.5 Stars
5 Stars
2012
$831
$856
$861
$865
$865
$873
* Pro Forma Example. Assumes Flat Trend For Applicable and Specified Amounts.
CMS RAF Payment Calc
Rebates
 Overarching Methodology and Application of Rebates is
Likely Unchanged For 2012
 Rebate % Amounts Are Materially Lower in 2012 and
Beyond
Rebate as % of Savings
 Rebate % Amounts Are Materially Lower in 2012 and Beyond
– Three Year Phase-In of Revised Rebate %’s
– Percentages Driven by Plan’s STARS Rating
STARS Rating 2011 and Prior 2012
4.5+ Stars
75%
73.33%
3.5 to 4.0 Stars
75%
71.67%
< 3.5 Stars
75%
66.67%
2013
71.67%
68.33%
58.33%
2014
70%
60%
50%
Changes to Rebate %
Example
Benchmark
Bid
Savings
2011
2012
2013
2014
$
900 $
900 $
900 $
900
$
800 $
800 $
800 $
800
$
100 $
100 $
100 $
100
Rebate %
4.5+ Stars
3.5 to 4.5 Stars
< 3.5 Stars
Rebate Amount
4.5+ Stars
3.5 to 4.5 Stars
< 3.5 Stars
75%
75%
75%
$
$
$
75 $
75 $
75 $
73.33%
70.00%
66.67%
73 $
70 $
67 $
71.67%
65.00%
58.33%
72 $
65 $
58 $
70%
60%
50%
70
60
50
Documentation and Coding for Skin Ulcers
Presented by:
Mary Jo Groome, CCS-P, CPC-H
Sr. Training and Development Consultant
Diseases of the Skin and Subcutaneous Tissue
Category 707
Chronic Ulcer of Skin
707.0x Pressure ulcer
707.2x Pressure ulcer stages
707.1x Non-pressure ulcer
Pressure Ulcers – 707.0x
 Documentation may identify synonymous terms for
decubitus ulcers such as bed sores, plaster ulcer,
pressure sore or pressure ulcer.
 Documentation of pressure ulcer stage is integral to
measurement of quality of care by providing a means
by which coded records can be used as a part of
internal and external health care quality improvement
endeavors to promote prevention, healing and reduce
the risk of pressure ulcers in the health care
environment.
Pressure Ulcers – 707.0x
 Two codes are needed to completely describe a pressure
ulcer:
– Assign the appropriate code for the site of the ulcer from
subcategory 707.0 with an additional code from
subcategory 707.2 to specify the stage of the ulcer.
The pressure ulcer stage codes will only be used with ulcers
documented as “pressure” ulcers or “decubitus” and not with
other types of ulcers (e.g. stasis ulcers)
Coding Ulcers: Decubitus / Pressure By Site
 Pressure Ulcer
– Use additional code to identify pressure ulcer stage (707.20-707.25)
–
–
–
–
–
–
–
–
–
707.00 – Pressure Ulcer, unspecified site
707.01 – Pressure Ulcer, elbow
707.02 – Pressure Ulcer, upper back
707.03 – Pressure Ulcer, lower back
707.04 – Pressure Ulcer, hip
707.05 – Pressure Ulcer, buttock
707.06 – Pressure Ulcer, ankle
707.07 – Pressure Ulcer, heel
707.09 – Pressure Ulcer, other site
Coding Ulcers: Decubitus / Pressure By Stage
 Pressure Ulcer Stages
– Code first site of pressure ulcer (707.00-707.09)
–
–
–
–
–
–
707.20
707.21
707.22
707.23
707.24
707.25
Pressure ulcer, unspecified stage
Pressure ulcer, stage l
Pressure ulcer, stage II
Pressure ulcer, stage lll
Pressure ulcer, stage lV
Pressure ulcer, unstageable
 Note: It is important to code both the location and the stage (depth).
Pressure Ulcer Staging – 707.2x
 707.2x Pressure Ulcer Stages (Code first site of pressure ulcer 707.00-707.09)
TIP: If a pressure ulcer progresses during an encounter from one stage to another, assign only
the code for the higher stage; only pressure ulcers are staged.
– 707.20 Pressure ulcer, unspecified stage
• Healing pressure ulcer NOS
• Healing pressure ulcer, unspecified stage
– 707.21 Pressure ulcer stage I
• Healing pressure ulcer, stage I
• Pressure pre-ulcer skin changes limited to persistent focal erythema
– 707.22 Pressure ulcer stage II
• Healing pressure ulcer, stage II
• Pressure ulcer w abrasion, blister, partial thickness skin loss involving
epidermis and/or dermis
Pressure Ulcer Staging – 707.2x
 707.2x Pressure Ulcer Stages
– 707.23 Pressure ulcer stage III
• Healing pressure ulcer, stage III
• Pressure ulcer with full thickness skin loss involving damage or
necrosis of subcutaneous tissue
– 707.24 Pressure ulcer stage IV
• Healing pressure ulcer, stage IV
• Pressure ulcer with necrosis of soft tissue through to underlying
muscle, tendon or bone
– 707.25 Pressure ulcer, unstageable
• TIP: Assign only if ulcer is covered by eschar, has been treated with skin or
other graft, or is documented as a deep tissue injury but not documented as
due to trauma.
Know the Difference
 Code 707.20 Pressure ulcer, unspecified stage
– Should be assigned when there is no documentation regarding
the stage of the pressure ulcer
 Code 707.25 Pressure ulcer, unstageable
– Should be used for pressure ulcers whose stage cannot be
clinically determined (e.g. the ulcer is covered with eschar or
has been treated with a skin or muscle graft).
– Pressure ulcers that are documented as deep tissue injury but
not documented as due to trauma.
Example
Non-surgical pressure ulcer located on left heel measuring
about 2.5cm. Unable to classify (stage) because of area of
black tissue (necrosis) on 100% of ulcer base. Surrounding
tissue has bruising extending about 1.5cm out towards the
toes. Tenderness noted when bruised area is touched.
Coding Scenario – Pressure Ulcer
 A patient is seen for treatment of Stage II healing pressure
ulcer of the left buttock.
– Code assignment
• 707.05 Pressure ulcer, buttock
• 707.22 Pressure ulcer stage II
Coding Scenario – Pressure Ulcer
 An elderly patient is being seen in an extended care facility
for treatment of a stage III pressure ulcer of the heel. The
NP also identifies the patient as a Type I diabetic with
related progressive PVD.
– Code assignment:
•
•
•
•
707.07 Pressure ulcer, heel
707.23 Pressure ulcer, stage III
250.71 DM w peripheral circulatory disorders, Type I, unspec
443.81 Peripheral angiopathy in diseases classified elsewhere
Examples
 Unfortunately, some patients may suffer from more than one
pressure ulcer, and these ulcers may be at the same or different
sites and stages. Here are some examples of documentation
and coding:
– Pressure ulcer both buttocks, both stage II
• 707.05 (buttock) and 707.22 (stage II)
– Pressure ulcer both buttocks, one stage II and one stage III
• 707.05 (buttock), 707.22 (stage II) and 707.23 (stage III)
– Pressure ulcer of left buttock and left elbow both stage II
• 707.05 (buttock), 707.01 (elbow) and 707.22 (stage II)
– Admitted with stage II pressure ulcer of buttocks, which
advanced to stage III during encounter
• 707.05 (buttock) and 707.23 (stage III)
Pressure Ulcer Example
 Recurrent Decubitus Ulcer with Failed Graft:
– A recurrent pressure ulcer that has had a failed graft(s) is
reported with 996.52 Mechanical complication of device
implant or graft and a code from the 707.0 subcategory
Look up:
Complications
graft
skin
infection or inflammation 996.69
rejection 996.52
Pressure Ulcers
 Care should be taken to distinguish between:
– pressure ulcers documented as “healed” (no code assigned)
– and “healing” (assign the appropriate code for the site and the
stage documented).
Diseases of the Skin and Subcutaneous Tissue
Category 707
Chronic Ulcer of Skin
707.1x Non-pressure ulcer
707.1 Ulcer of Lower Limb, except pressure
ulcer
 707.1x Ulcer of lower limbs, except pressure ulcer
– Ulcer, chronic
• Neurogenic
• Trophic
Causal condition…code first:
atherosclerosis of the extremities w ulceration (440.23 + ulcer
code)
diabetes mellitus (250.80-250.83/249.80-249.83 + ulcer code)
Coding Ulcers: Chronic, Ischemic, Lower Extremity
 Subcategory 707.1x Ulcer of lower limbs, except
pressure ulcer
▪ First:
Code any underlying or causal condition
Example:
- 440.23 – Atherosclerosis of Extremities w/ Ulceration
- 250.8x – Diabetes w/ Other Chronic Manifestations
▪ Second:
Code associative ulcers to the highest level of specificity
Example:
•
•
•
•
•
•
•
707.10 – Ulcer of lower limb, unspecified
707.11 – Ulcer of thigh
707.12 – Ulcer of calf
707.13 – Ulcer of ankle
707.14 – Ulcer of heel and midfoot
707.15 – Ulcer of other part of foot
707.19 – Ulcer of other part of lower limb
 Chronic ulcer of unspecified site – 707.9
 Varicose ulcer (lower extremity, any part) – 454.0
707.1x Ulcer of lower limbs, except pressure ulcer
 If ulceration is associated with arteriosclerosis of the
extremities code:
– 440.23, Atherosclerosis of the extremities with ulceration
– Additional code from 707.10-707.19 (non-pressure ulcer)
–
–
–
–
–
–
707.10 Ulcer of lower limb, unspecified
707.11 Ulcer of thigh
707.12 Ulcer of calf
707.13 Ulcer of ankle
707.14 Ulcer of heel and midfoot
707.15 Ulcer of other part of foot
– Toes
– 707.19 Ulcer of other part of lower limb
Nursing Facility Example
 Case 3
89 yo female with hx of PVD,Hypertensive Heart Disease
Vascular PE: Bilat severe rubor noted. R ankle noted to have ulcer to
lateral malleolus. Ulcer improved from last assessment. Continues 1
cm diameter open area with slight area of redness around ulcer.
Redness has improved from last week.
 Diagnosis 440.23 Atherosclerosis of native arteries of the
extremities with ulceration
Chronic: Pt with obvious PVD. Ulcer to R outer malleolous to be
treated with Bactroban and covered with window dressing to let wnd
breath. Staff states wnd is improving. Continue to monitor progress
of wnd and staff to inform NP/PCP of any increased drainage,
redness, heat to area.
Documentation & Coding PAD / PVD
A condition potentially related to PAD is
atherosclerosis.
– Atherosclerosis of native arteries of the extremities is
classified to code 440.2x. A fifth-digit subclassification is
required to differentiate the type of atherosclerosis as follows:
Atherosclerosis of the extremities,
» With ulceration 440.23
Use additional code for any associated ulceration (707.10-707.9)
» With gangrene 440.24
Use additional code for any associated ulceration (707.10-707.9)
707.1x Ulcer of lower limbs, except pressure ulcer
 The underlying cause of foot ulcers in a diabetic patient may be diabetic
neuropathy (250.6x), diabetic peripheral vascular disease (250.7x) or
“other specified diabetic ” (250.8x) depending on documentation.
 e.g. Patient has diabetic neuropathy and an associated ulcer of the left
great toe.
– Codes 250.60, 357.2 and 707.15
 e.g. Patient’s diabetic PVD has resulted in an ulcer of the right midfoot.
– Codes 250.70, 443.81 and 707.14
 e.g. Patient has a diabetic ulcer of the left ankle
– Codes 250.80 and 707.13
Be Specific
▪ Wound Care
Do not choose the word “open wound” or “lesion” in
your documentation if you really mean “pressure” or other
forms of non-healing ulcers.
●
●
●
Wound – open (by cutting or piercing instrument)(by
firearms) (cut) (dissection) (incised) (laceration)
(penetration) (perforating) (puncture) (with initial
hemorrhage, not internal) ICD-9 notation
Ulcer, Ulceration – a local defect/excavation of the
surface of an organ or tissue produced by sloughing
of necrotic inflammatory tissue
Pressure Ulcer – bed sore, plaster ulcer, decubitus
ulcer
Be Specific
▪ Wound Care for the Leg
– The chart documentation and choice of words determines
the coding:
Open Wound
Ulcer
Knee, leg (except thigh)
ankle
Pressure Ulcer
(code Stage also)
891.0
w/o comp.
707.10
lower, unsp
707.01
elbow
891.1
complicated
707.11
thigh
707.02
upper back
891.2
w/ tendon
involvement
707.12
calf
707.03
lower back
707.13
ankle
707.04
hip
707.14
heel/midfoot
707.05
buttock
707.15
other part of
foot (toes)
707.06
ankle
707.19
other part of
lower limb
707.07
707.09
heel
other site
Documentation Makes the Difference
1. Patient’s ulcer appears to be healing. 707.9
2. Patient’s pressure ulcer appears to be healing. 707.00, 707.20
3. Patient’s stage III decubitus ulcer appears to healing. 707.00, 707.23
4. Patient’s decubitus stage II heel ulcer appears to be healing. 707.07, 707.22
5. The patient’s open wound on the left heel appears to be healing. 892.0
6. Physical exam reveals varicosities on the right lower leg that have ulcerated. 454.0
7. Varicose veins with ulceration and hemorrhage. 454.0
8. The patient’s left heel ulcer has healed nicely. No code
Sample Documentation
 History states: “PVD with ulcers”
 Exam states: “SKIN: Current Status: Bilateral ace wraps to legs in
place.” “CARDIOVASCULAR: BASELINE: Regularly irregular rhythm.
S1, S2. No M/C/R. 2+ BLE nonpitting edema. No JVD. Ace wraps
BLE. Current Status: RRR S1 S2. No murmur.”
 Diagnosis : 443.9 - Unspecified peripheral vascular
disease Treatment Plan : PVD is most likely secondary to long history
of HTN and CAD. Continue with supportive care of chronic wounds and
edema management. Consult wound nurse with AMT prn. Recurrence of
wounds expected. Continue with podiatry care.
 Diagnosis : 707.10 - Ulcer of lower limb, unspecified
Medications : Zinc Sulfate; Treatment Plan : refer to 443.9
 Comments: This represents correct coding for the PVD and ulcers based on the documentation. We cannot
code the causal condition when it is documented as “most likely secondary to”.
– If the documentation had stated “PVD is secondary to long history of HTN and CAD”, we would
code 401.9 (HTN), 414.00 (CAD) and 443.81 (peripheral angiopathy in diseases classified
elsewhere).
– If the documentation had stated ulcer due to arteriosclerosis or arteriosclerotic ulcer, we would
code 440.23 (atherosclerosis of the native arteries of the extremities with ulceration) and 707.10.
Sample Documentation
 His R foot has a 2.5 cm x 1.2 ulceration weeping serosanguinous drainage after podiatry debrided 2 days ago.
 Comments: Because we do not know the type of the ulcer,
we can only code by site 707.15 – Ulcer of other part of
foot.
Sample Documentation
 History states: “Skin: Decubitus ulcer, 2007”
 Exam states: “Skin:…. Decubitus ulcer to sacrum/buttocks,
followed by treatment nurse.”
 Treatment plan states: “…, resident with coccyx/sacral ulcer,
open area from hospitalization in July, exact measurements in
wound care nurses records.”
 Diagnosis: does not mention ulcer
 Comments:
– Code 707.03 – Pressure ulcer, sacrum – and code 707.05 – Pressure
ulcer, buttock – should be added to reported diagnoses.
– We are unable to code the specific stage of the ulcer due to lack of
documentation, so we would code also 707.20 – Pressure ulcer,
unspecified stage.
Coding Ulcers: A Summary
 Pressure ulcer documentation needs to address the site
(707.0x) of the pressure ulcer and the stage (707.2x).
Both risk adjust but are bundled into each other (HCC
148).
 If documentation indicates a “healed” ulcer, no code is
assigned. A “healing” ulcer is coded to the correct
category.
 Non-pressure ulcers of the lower limb code to
subclassification 707.1x.
 If the ulcer is due to a causal condition such as diabetes
or atherosclerosis, the causal condition is coded first.
Coding Ulcers: A Summary
 Based on Causal Condition:
 Arteriosclerosis of extremities with ulceration – 440.23
– Use additional code for any associated ulceration (707.10 –
707.9)
 Diabetic ulcer – 250.8x, 707.9
– Specify site and code specifically to site: 250.8x, (707.10 –
707.9)
– If provider documents diabetic ulcer as a neurologic
manifestation or a peripheral circulatory manifestation, code to
250.6x or 250.7x respectively
 Varicose ulcer (lower extremity, any part) – 454.0
For More Information…
Revised Future Documentation &
Coding Topics
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July – no meeting
August – Venous Thrombosis
September – Major Depression
October – Peripheral Artery Disease
November – Cirrhosis
December - COPD
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Question and Answer
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