Puzzled Over Coding Diabetic Foot Ulcers?

  • Gretchen Dixon, MBA, RN, CCS, CPCO, AHIMA Approved ICD-10-CM/PCS Trainer
  • Volume 07 - Issue 2

The following are a few slides excerpted from the online course, Wound Care Documentation and Coding ICD-10-CM Diabetic Foot Ulcer, that share the depth of information you will learn and be able to use in real time on your next wound-care clinical documentation improvement and coding opportunity.

The six elements in Slide 1 are vital to the selection of an ICD-10-CM code with the highest  level of specificity. Each element not documented weakens the specificity of the ICD-10-CM code selection, which has the potential to jeopardize the medical necessity of patient care and possible reimbursement.



Does your clinical documentation support a high level of acuity?

Another example of weak clinical documentation is the actual description of nonhealthy wound tissue. Clinicians need to document their professional observation of each individual patient’s wound. Often the point-click options with an electronic health record does not provide this level of specificity describing the appearance of the nonhealthy tissue, noted in Slide 2. The more details clinically provided demonstrates a higher level of acuity supporting the intensity of services and complexity of care provided to the patient. Speak with the EHR developers to ensure you have adequate space to document in free text your professional observation, thus providing an individuality of information into the patient’s medical record.

Unspecified ICD-10-CM codes may cause a risk to financial stability of your department.

There is a place for unspecified diagnosis codes; however, the wound-care environment should not be the place where they are selected. Unspecified codes can cause a risk and a liability for what service is billed because they don’t accurately reflect the level of acuity, the intensity of services and the complexity of care provided to the patient. An unspecified code may not support medical necessity of services such as a debridement.

Be proactive and THINK-N-INK about selecting the most descriptive ICD-10-CM code supported with your clinical documentation. HINT: Most third-party payers have been monitoring and continue to monitor the submission of unspecified codes on claim forms. It is anticipated that routine billing of unspecified ICD-10-CM codes may result in a reduced reimbursement rate once the data has been messaged and like medical specialties compared in the future. Additionally, a third-party payer could exclude a physician, practice or service from their contract if they feel the information data does not accurately provide the supporting evidence of medical necessity of patient care.



What are the day-to-day risk liability issues? Where does your practice or department fit in to this activity? Can you afford the risk? Slide 3 provides some of the top identified issues.

Learn more by joining the 60-minute informative webinar at http://woundeducationpartners.com/online-courses/ browse-course-list.html. You will challenge yourself on code selection for diabetic foot ulcers in ICD-10-CM. The user- friendly information will improve your understanding of coding applications, provide answers to many of your coding questions, and reinforce your current knowledge of this topic.

At the end, you should have a clarified understanding of the value this session offers for those working in the wound- care department. Mitigating possible denials or claim holds through accurate, clear, detailed and cohesive clinical documentation is vital to ensure there is an even flow of revenue for services provided. Also, clinical documentation provides a level of granularity and specificity for an accurate ICD-10-CM diagnosis(es) code(s), which supports the reason for services provided to the patient. This involves not only selecting the diagnoses codes but also sequencing the primary code that represents the reason for the patient’s visit.



There is a must for understanding the specific application of the current year’s Official Guidelines for Coding and Reporting Outpatient Services as it relates to the bottom line of your department's operation. References are included for your personal library.


Affordable Care Act: http://www.hhs.gov/healthcare/facts/bystate/ Making-a-Difference-National.html

Best Practices for ICD-10-CM Documentation and Compliance. Code It Right; 2012.

CMS ICD-10 direction for unspecified codes: http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD-10QuickRefer.pdf

CMS Medicare FFS Provider e-News May 16, 2013: http://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2013-05-16-Enews.pdf

ICD-10-CM Official Guidelines for Coding and Reporting: Section B: General Coding Guidelines, subsection 18: Use of Sign / Symptom / Unspecified Codes: https://www.cms.gov/Medicare/ Coding/ICD10/Downloads/2016-ICD-10-CM-Guidelines.pdf

Optum 2015 UCD-10-CM/PCS Coding Readiness Assessment Manual 

Optum 2015 ICD-10-CM Clinical Documentation Improvement Desk Reference

Optum 360° 2016 ICD-10-CM Coding Manual.

Optum Evaluation and Management Coding Advisor Manual, 2013.

Wound Management and Healing, 2nd Edition. Western Schools; 2012.


Free Mini-Course: The Business of Wound Care and Hyperbaric Medicine

Join us for this free 4-part mini-course and jump start your clinic business today! 
  • Are you a clinic manager or medical director who wants to increase patient load and referrals but has no money for marketing?
  • Could you be losing money due to incorrect billing and coding?
  • Do you want to become a profit center for the hospital but inefficient business operations are holding your clinic back?

If you don't know where to start, how to start, or what you need to know to take your clinic to the next level, this free 4-part mini-course is for you.

This mini-course is taught by Dr. Michael White, MD, MMM, CWS, UHM and course director for the live two-day workshop, The Business of Wound Care and Hyperbaric Medicine.

You Will Learn:

Lesson 1: [Video] How to create a strong (or stronger) foundation for your clinic business

  • How to identify where your patient referrals are coming from (or should be coming from).
  • How to create an action plan for effective, efficient marketing.
  • How to become a profit center for the hospital.

Lesson 2: [Video] The explosion of chronic wounds in the U.S. and the opportunity for wound care and hyperbaric medicine clinics to serve more patients.

Lesson 3: 4 Easy steps to market your clinic.

Lesson 4: How key are front office operations to the wound clinic business?

  • Learn the two key considerations for creating efficient front office operations that contribute to the achievement of your clinic's overall financial goals.
Join us for this free 4-part mini-course and jump start your clinic business today! 


About the Author

GRETCHEN DIXON, MBA, RN, CCS, is the owner of Professional Compliance Strategies (PCS), LLC, and consults on outpatient departments and physician services. She has provided revenue- cycle compliance audits of services with a focus on wound care department operations for more than 10 years. She holds several credentials including an MBA in healthcare management, an RN with a practicing license in New York, and 23 multistate licensure from Virginia, AHIMA Certified Coding Specialist (CCS), AHIMA ICD-10-CM/PCS Approved Trainer, and is an AAPC Certified Professional (Healthcare) Compliance Officer. A longtime internal healthcare auditor, Dixon identifies issues through audits of D, C, B (documentation, coding and billing) of provided services. The outcome of each audit determines the topics of education to be provided to the staff and physicians, as she proactively believes education is the key to having complete, accurate, and consistent documentation supporting reimbursement for billed services. If you are interested in her services, contact Dixon at This email address is being protected from spambots. You need JavaScript enabled to view it. or call 1-615-210-7476.

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