New Coding Changes Coming For Pressure Ulcers And Pressure-Related Tissue Damage

Every year, there are changes to ICD10-CM. This year, there are 273 additions, 21 deletions, and 30 revisions that all go into effect October 1, 2019. The change that will likely be most pertinent to podiatrists is the addition of a new sixth character option for the L89-series of codes. These are the codes used for pressure-related changes to skin.

When coding for lower extremity skin changes that result from prolonged pressure, we will continue to start with one of the following code stems:

L89.51- Pressure ulcer of right ankle

L89.52- Pressure ulcer of left ankle

L89.61- Pressure ulcer of right heel

L89.62- Pressure ulcer of left heel

L89.89- Pressure ulcer of other site

Each of these code stems require a sixth character to complete the code, and up until now those options have been: 

0 - Unstageable

1 – Stage 1

2 – Stage 2

3 – Stage 3

4 – Stage 4

9 – Unspecified stage

The character options listed above will remain and a new L89-series sixth character will go into effect October 1, 2019. This new character option of “6” will indicate, “pressure-induced deep tissue damage.” For example, L89.626 will be “pressure-induced deep tissue damage of left heel.”

Distinguishing Between Pressure Ulcer And Pressure-Induced Deep Tissue Damage

With the addition of this new sixth character option and the need to support our coding with our documentation, it becomes more important to differentiate between “pressure ulcer” and “pressure-induced deep tissue damage.” According to the National Pressure Ulcer Advisory Panel (NPUAP), a pressure injury is “localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device.”¹ However, the Centers for Medicare and Medicaid Services (CMS) consider Stage 1 to be deep tissue injuries and Stage 2, 3, or 4 to be pressure ulcers.²

 So How Do We Code?

Given the above guidance from CMS, starting October 1, 2019, I suggest using the following L89-series sixth character options for skin changes due to prolonged pressure:

  Unstageable - sixth character “0”

Stage 1- sixth character “6”

Stage 2 - sixth character “2”

Stage 3 - sixth character “3”

Stage 4 - sixth character “4”

Dr. Lehrman operates Lehrman Consulting, LLC, is a consultant to the APMA Health Policy and Practice Department, serves as an expert panelist on Codingline, and is a Certified Professional Coder. Follow him on Twitter @DrLehrman.

References

1. National Pressure Ulcer Advisory Panel. NPUAP pressure injury stages. Available at:  https://cdn.ymaws.com/npuap.site-ym.com/resource/resmgr/npuap_pressure_injury_stages.pdf. Published April 9, 2016. Accessed August 5, 2019. 

2. Centers for Medicare and Medicaid Services. Pressure ulcers resource. Centers For Medicare And Medicaid Services Partnership For Patients. Available at: https://partnershipforpatients.cms.gov/p4p_resources/tsp-pressureulcers/toolpressureulcers.html. Accessed August 5, 2019.

3. Centers for Medicare and Medicaid Services. 2020 ICD-10-CM. Available at: https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM.html. Published July 18, 2019. Accessed August 5, 2019.