Wound Vs Ulcer Diagnosis Coding – What to Know

“Wound” and “ulcer” are 2 major categories of wounds from the ICD-10 coding perspective – the acute form is categorized as wound and the chronic form is categorized as ulcer. While wounds are caused by an external force, ulcers are the result of some internal issues. An ulcer is a break in the skin that fails to heal in a normal period. Often, medical coding staff may get confused whether to select a wound code or an ulcer code for certain injuries. One of the main advantages of medical billing outsourcing is that medical practices and other healthcare providers get to work with AAPC- and AHIMA- certified coders, who can assign the right medical codes.

Coding Terms used for Acute Wounds Include: superficial injuries (contusions, abrasions, blisters, external constriction, injuries with foreign bodies, non-venomous and venomous insect bites and other superficial bites); open wounds (lacerations with and without foreign bodies, puncture wounds with and without foreign bodies, trauma wounds, and open bites); skin trauma (crush injuries, partial and total traumatic amputations, burns and corrosions, open fractures, and frostbite); surgical wounds; acute disease wounds (acute/subacute osteomyelitis), and post-surgical complications (caused by grafts, surgical wounds).

Coding terms for Chronic Wounds or Ulcers Include: pressure ulcers; non-pressure ulcers; varicose veins with ulcers; atherosclerotic disease with ulcers; diabetic ulcers or chronic osteomyelitis. Ulcers are usually associated with underlying chronic conditions such as venous disease, diabetes and others.

ICD-10 Codes For Injuries and Wounds

Wound codes begin with the letter “S” in Chapter 19 of the ICD-10 tabular index titled, “Injury, poisoning, and certain other consequences of external causes”. The S and T section provides codes for the various types of injuries related to body areas.

• S00-S09 – Injuries to the head
• S10-S19 – Injuries to the neck
• S20-S29 – Injuries to the thorax
• S30-S39 – Injuries to the abdomen, lower back, lumbar spine, pelvis and external genitals
• S40-S49 – Injuries to the shoulder and upper arm
• S50-S59 – Injuries to the elbow and forearm
• S60-S69 – Injuries to the wrist, hand and fingers
• S70-S79 – Injuries to the hip and thigh
• S80-S89 – Injuries to the knee and lower leg
• S90-S99 – Injuries to the ankle and foot
• T07 – Injuries involving multiple body regions
• T14 – Injury of unspecified body region
• T15-T19 – Effects of foreign body entering through natural orifice
• T20-T25 – Burns and corrosions of external body surface, specified by site
• T26-T28 – Burns and corrosions confined to eye and internal organs
• T30-T32 – Burns and corrosions of multiple and unspecified body regions
• T33-T34 – Frostbite
• T36-T50 – Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances
• T51-T65 – Toxic effects of substances chiefly nonmedicinal as to source
• T66-T78 – Other and unspecified effects of external causes
• T79 – Certain early complications of trauma
• T80-T88 – Complications of surgical and medical care, not elsewhere classified

Tips to Determine Whether to Select a Wound Code or an Ulcer Code

Wound Care Learning Network provides some key tips coders can consider when coding wounds and ulcers.

• • Make sure to code each ulcer and wound separately. Even if the scenario is to report treatment for multiple sites at the same encounter, choose the distinctive diagnosis codes for each wound or ulcer.
  • If the diagnosis codes are different even by a single character, but the wounds or ulcers are similar, remember to report each site’s diagnosis code.
  • Multiple injuries can be connected to different treatments even on the same date of service. Link the right ICD-10 code for the wound or ulcer site to the provided treatment. Assigning the right codes helps the payer understand the longitudinal treatment of a single wound or ulcer, and which treatments were provided to multiple wounds or ulcers.
  • For wounds with infection, additional codes are necessary to describe the infection agent. Use post-op complication codes for infection after surgery and add the additional organism code(s) for infections that is not due to surgery.
  • Even though most payers require chronic ulcer to be listed first, from a coding perspective the underlying cause is listed first and then the type of ulcer.
  • Non-healing wounds or ulcers do not require a 7th character extender to report episode of care.

• The code listed first for an office/outpatient clinic visit could be an infection, complication, and/or a new wound or ulcer of a different site rather than the wound or ulcer itself. Coders should consider what diagnosis required most of the treatment during the patient visit.
• For complications related to previous open or traumatic wound, mention the site of the wound with sequela (S) to indicate a relationship to a previous injury.
• Try not to use codes such as T14.8 (other injury of unspecified body region) or T14.9 (injury, unspecified), as these codes do not describe the location or type of wound. A 7th character is needed to indicate the episode of care.

As there are a number of codes in the list, choosing the right diagnosis codes for wounds or ulcers can be really confusing. Practices providing wound care treatment can consider partnering with an experienced medical coding company to ensure accurate reporting of the treatments provided on their medical claims.

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Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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