Foot ulcer in the setting of peripheral artery disease

danielle.stevens@essentiahealth.orgdanielle.stevens@essentiahealth.org
in Home Care Coding General
MD documented Foot ulcer in the setting of peripheral artery disease, would I code this to a non pressure ulcer following I73.9?

Thanks!

Danie Stevens
Home Health Coder, RHIT
Essentia Health St. Mary's
1027 Washington Ave, Detroit Lakes, MN 56501
218-847-0857
Danielle.Stevens@essentiahealth.org

Comments

  • kupton@nhccare.comkupton@nhccare.com
    edited May 2017
    In our practice we have received clarification regarding this and have interpreted PAD as atherosclerosis of the arteries. I'm certain we are to avoid nonspecific codes, when possible. The depth of the wound and laterality is required and the 6th digit of "9" should be avoided particularly concerning wounds of any type (including pressure ulcers) that will be treated by a provider or skilled clinician.

    Peripheral artery disease with ulcer of foot (not stated as related to pressure) should be assigned as (choose your 5th and 6th digits to identify the laterality and the depth of the wound):
    I70. 2x4 (or .2x5) - Atherosclerosis of native artery of leg
    L97. 5xx - Non-pressure ulcer of foot

    Has anyone learned differently? I'd be curious to know and I'm always looking to make sure we've received accurate guidance. I hope this helped someone. Thanks.
    Karen Upton, RN, BSN, HCS-D, COS-C
    AHIMA Approved ICD 10 CM/PCS Trainer
    NHC HomeCare
    o: 615-890-2020 Ext. 1812
    f: 615-278-3043
    kupton@nhccare.com
  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited May 2017
    Morning Karen.
    Per the NIH, "The most common cause of (PAD) is atherosclerosis" meaning there are other causes of PAD.
    In the Decision Health Coding Center "Coding Tips" for I73.9 Peripheral vascular disease, unspecified, it states:
    "Do not assign I73.9 when peripheral atherosclerosis is reported in the clinical record. Note, atherosclerosis of the extremities is a more specific diagnosis and should be coded using a code from I70.2- through I70.7-.

    I73.9 is used for peripheral vascular disease and peripheral arterial disease (angiopathy). If the physician documents venous disease, I80-I89 should be referenced."

    The generic advise of avoiding the "9" non-specific codes is good, but not always the case for certain coding scenarios.
    When physician documentation states "due to atherosclerosis", then the more specific codes are used.
    Again, it is dependent on the physician documentation as far as how specific one can code. If the documentation if not specific, the we cannot avoid use of non-specific codes.

    Good discussion. Thank you.

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
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