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CODES.AND.STUFF

A RESOURCE FOR CLINICAL CODERS IN THE UK

When coding leg ulcers using ICD-10 codes it is important that associated gangrene and/or infection of the affected leg are coded in addition to the leg ulcer:

If the infective agent has been identified, then an additional code from ICD-10 categories B95-B97 Bacterial, viral and other infectious agents, must be assigned as a supplementary code.

Leg ulcer with gangrene

Example 1:

Patient diagnosed with a leg ulcer and gangrene of the leg. The correct ICD-10 codes and sequence are:

L97.X Ulcer of lower limb, not elsewhere classified

R02.X Gangrene, not elsewhere classified

Example 2:

Patient diagnosed with a leg ulcer and gangrene of the leg due to type 2 diabetes mellitus. The correct ICD-10 codes and sequence are:

E11.5 Non-insulin-dependent diabetes mellitus, with peripheral circulatory complications

L97.X Ulcer of lower limb, not elsewhere classified

R02.X Gangrene, not elsewhere classified

Infected leg ulcer

Example 3:

Patient diagnosed with an infected/infectious leg ulcer. Streptococcus group A is identified as the infectious agent. The correct ICD-10 codes and sequence are:

L97.X Ulcer of lower limb, not elsewhere classified

L08.9 Local infection of skin and subcutaneous tissue, unspecified

B95.0 Streptococcus, group A, as the cause of disease classified to other
chapters

Leg ulcer with cellulitis of the leg

Cellulitis is the spreading of inflammation. It is a bacterial infection which usually enters the skin via a wound or another break in the skin. The affected area is hot, tender and red. The patient may also be feverish and have chills. Treatment usually consists of elevation, rest and administration of pathogen-specific antibiotics. If cellulitis of the leg is mentioned with a leg ulcer, then both conditions must be coded. Clinical advice must be sought if it is not clear whether the cellulitis or the leg ulcer is the main condition being treated during the relevant episode of care.

Example 4:

Patient is admitted with cellulitis of the leg and a superficial leg ulcer. The cellulitis is responding poorly to oral antibiotics. A decision is made to treat the cellulitis with intravenous antibiotics. The correct ICD-10 codes and sequence are:

L03.1 Cellulitis of other parts of limb

L97.X Ulcer of lower limb, not elsewhere classified

Example 5:

A patient is admitted with cellulitis of the leg and a severe leg ulcer. The cellulitis is responding well to treatment with oral antibiotics, but the leg ulcer is showing no signs of healing. The patient is sent to theatre for debridement of the leg ulcer under general anaesthetic.

The correct ICD-10 codes and sequence are:

L97.X Ulcer of lower limb, not elsewhere classified

L03.1 Cellulitis of other parts of limb

Date published: 05/2010 (Volume 7 Issue 2)

Coding Clinic, NHS Classifications Service

www.connectingforhealth.nhs.uk/codingclinic

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