I70 Wound Ulcer Group 2 Codes

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Hello,
Looking for clarification on proper use of the I70 codes that are listed under "Group 2 - Wound Ulcer Codes" and include various locations of the leg and foot.

I have a patient with DM, now resolved foot ulcers, but current LLE ulcer x 2. Recent surgical debridement/abscess. Current initial treatment of 6 weeks IV antibiotics for OM.

Can I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower left leg, plus a diabetic code be used for HBOT? The ulcers are very clearly not below the ankle, so cannot be a DFU, but the I70 codes are listed under "Diabetic Wounds of the Lower Extremity" in the ICD coding section.

There has not been any acute arterial event.

Thank you!

Mar 19, 2024 by Sarah Karson, RN, BSN

3 replies

Tiffany Hamm
BSN, RN, CWS, ACHRN, UHMSADS

Hi Sarah,

Regarding your question: Can I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower left leg, plus a diabetic code be used for HBOT? In short, the answer is No. DFU's are neuropathic ulcers which are precipitated and perpetuated by the combined effects of motor, sensory, and autonomic neuropathies in patients with diabetes. These primarily effect the striking surface of the forefoot and hindfoot (nomenclature often used in classification systems) that are subject to repeated trauma and pressure.

Although the codes are present in the HBO Crosswalk DFU coding section, CMS clearly states that in order to treat with HBOT, ulcer location must be on the foot. Since this patient's ulcers on are on the LE, HBO will not be an indication.

It would be nice if the HBO crosswalk CMS provides would clarify this, but we know from denied claims due to post payment review audits, that billing HBO for LE ulcers is fraudulent.

Thank you,

Tiffany

Mar 19, 2024

Sarah Karson
RN, BSN

Thank you for your response, Tiffany. With the definition of a DFU, it doesn't seem there is any place otherwise, for the use of the atherosclerosis with ulceration codes in HBOT.

Mar 20, 2024

Sarah Karson
RN, BSN

Hi! To clarify for an ulcer that IS on the foot, for a patient that has both PAD and DM, shouldcan an atherosclerosis code + DM code be used? Or strictly non-pressure ulcer code + DM for DFU, since this ulcer would be precipitated and perpetuated by the combined effects of motor, sensory, and autonomic neuropathies in patients with diabetes? Thus if the ulcer is originating from a PAD origin, we cannot call it a DFU, and thus it is not covered?

Apr 24, 2024

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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