Coding Answers for 1/12/15

ICD-9-CM Scenario A patient is admitted to home health with one Stage 4 pressure ulcer on the buttock that was recently treated with a muscle flap, is showing early/partial granulation and is the focus of care. The patient also has a Stage 3 pressure ulcer on the hip. Skilled nursing will perform wound care. Tip to remember: the OASIS may not always match the coding. V58.77 : The pressure ulcer was treated with a muscle flap, making it a surgical wound, so the after-care code is most appropriate as the primary code. 707.05: The treated pressure ulcer location code and its corresponding stage code are assigned directly after the surgical after-care code; in accordance with coding guidelines. 707.25: The stage is reported as unstageable for the treated pressure ulcer, because the wound bed is obscured by the muscle flap. 707.04: The second pressure ulcer is coded as a secondary diagnosis, including site and stage. 707.23 V58.31: This code indicates surgical dressing changes for muscle flap V58.30: This code indicates the non-surgical dressing changes for other pressure ulcer ICD-10-CM A 71-year-old man has multiple stasis ulcers on both ankles and both calves. One on his right ankle includes muscle necrosis, the others are limited to skin. All are infected with MRSA and VRSA. Care is directed at the ulcers, including wound care and IV administration for antibiotics.


I87.2, Venous insufficiency (chronic) (peripheral) This code is the ICD-9-CM equivalent to 459.81 Venous (peripheral) insufficiency, unspecified.  To find this code look up ulcer, stasis, without varicose veins.

L97.313: Right ankle non-pressure ulcer involving muscle necrosis

L97.211: Right calf non-pressure ulcer involving skin

L97.221: Left calf non-pressure ulcer involving skin

L97.321: Left ankle non-pressure ulcer involving skin

B95.62: MRSA in diseases classified elsewhere (This code is used when the infection is related to another disease, such as stasis ulcer)

Z16.62: Resistance to Vancomycin Antibiotics

Z45.2: Attention to vascular catheter Please let me know if you have any questions.  I’ll be posting the next scenario into a different post. 🙂

Sincerely, Kimberly

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