Venous Leg Ulcer Formation

Venous leg ulcers develop as a result of abnormal vein function.  When venous blood is not returned to the heart as it should be, it can accumulate in leg veins and cause pressure to the overlying skin.  This can lead to a decrease in oxygen and nutrient delivery to this area of the skin, which can lead to skin break down and ulcer formation.

Chronic Venous Hypertension

Chronic venous hypertension, sometimes referred to as chronic venous insufficiency, is a result of blood pooling in the legs when venous return is not sufficient. This can cause swelling of the lower extremity, the feeling of tightness, itching, pain with activity, and brown-colored skin, particularly near the ankles.

Varicose Veins

Varicose veins are twisted, enlarged, and typically a darker color than a healthy vein. They often appear to be “bulging.” Varicose veins can cause the feeling of heaviness of the legs, burning, itching, throbbing, and changes in the color of the skin surrounding and overlying the varicosity.

Coding

Venous leg ulcers are often found in the presence of chronic venous hypertension or varicose veins. When a venous leg ulcer occurs in the presence of chronic venous hypertension, ICD-10-CM codes to consider include:

I87.311 Chronic venous hypertension (idiopathic) with ulcer of right lower extremity
I87.312 Chronic venous hypertension (idiopathic) with ulcer of left lower extremity
I87.313 Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity
I87.331 Chronic venous hypertension (idiopathic) with ulcer and inflammation of right lower extremity
I87.332 Chronic venous hypertension (idiopathic) with ulcer and inflammation of left lower extremity
I87.333 Chronic venous hypertension (idiopathic) with ulcer and inflammation of bilateral lower extremity

When a venous leg ulcer occurs in the presence of varicose veins, ICD-10-CM codes to consider include:

I83.012 Varicose veins of right lower extremity with ulcer of calf
I83.013 Varicose veins of right lower extremity with ulcer of ankle
I83.022 Varicose veins of left lower extremity with ulcer of calf
I83.023 Varicose veins of left lower extremity with ulcer of ankle
I83.212 Varicose veins of right lower extremity with both ulcer of calf and inflammation
I83.213 Varicose veins of right lower extremity with both ulcer of ankle and inflammation
I83.222 Varicose veins of left lower extremity with both ulcer of calf and inflammation
I83.223 Varicose veins of left lower extremity with both ulcer of ankle and inflammation

References 

CMS.GOV 2022 ICD-10-CM 

Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC
Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

Dr. Lehrman is in private practice in Fort Collins, CO and operates Lehrman Consulting, LLC. He is a Diplomate of the American Board of Foot and Ankle Surgery, Fellow of the American Society of Podiatric Surgeons, and is recognized as a “Master” by the American Professional Wound Care Association. He is a Fellow of the American Academy of Podiatric Practice Management and an Expert Panelist on Codingline. In his role as a Consultant to the APMA Health Policy and Practice Department, Dr. Lehrman serves as an advisor to the APMA Coding Committee and the APMA MACRA Task Force. Dr. Lehrman sits on the board of directors of both the American Professional Wound Care Association and the American Society of Podiatric Surgeons. He is also on the editorial advisory board of the journal WOUNDS.