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L97.509
ICD-10-CM
Ulcer on Toe

Find information on ulcer on toe diagnosis, including clinical documentation, healthcare guidelines, and medical coding. Learn about ICD-10 codes for toe ulcers, differential diagnosis, treatment options, and wound care. This resource provides essential details for healthcare professionals, clinicians, and medical coders seeking accurate and comprehensive information related to ulcers on the toe.

Also known as

Toe Ulcer
Foot Ulcer
Diabetic Toe Ulcer

Diagnosis Snapshot

Key Facts
  • Definition : Open sore on a toe, slow to heal.
  • Clinical Signs : Pain, redness, swelling, drainage, exposed tissue.
  • Common Settings : Diabetes, peripheral artery disease, trauma, infection.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC L97.509 Coding
L97

Non-pressure ulcers of lower limb

Ulcers affecting areas of the leg, ankle, and foot, excluding pressure sores.

L89

Decubitus ulcer

Pressure sores or bedsores, often found on bony prominences like heels.

I70

Atherosclerosis

Narrowed arteries can reduce blood flow to extremities, contributing to ulcers.

E10-E14

Diabetes mellitus

Diabetes can impair healing and increase the risk of foot ulcers.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the ulcer due to diabetes?

  • Yes

    Site of ulcer?

  • No

    Is the ulcer due to pressure?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Toe ulcer
Diabetic foot ulcer
Arterial ulcer of toe

Documentation Best Practices

Documentation Checklist
  • Ulcer on toe location, laterality (ICD-10 L98)
  • Ulcer size, depth, characteristics (stage)
  • Presence of infection signs/symptoms
  • Vascular assessment, pulses, ABI if indicated
  • Pain description, impact on mobility/ADLs

Coding and Audit Risks

Common Risks
  • Unspecified Laterality

    Coding lacks right, left, or bilateral specificity, impacting reimbursement and data analysis. Review documentation for clarity.

  • Unconfirmed Etiology

    Documentation may not specify ulcer type (e.g., diabetic, pressure, venous). Accurate coding requires specific etiology documentation.

  • Missing Stage/Depth

    Lack of documentation on ulcer stage or depth impacts severity coding and subsequent treatment planning and resource allocation.

Mitigation Tips

Best Practices
  • Document ulcer location, size, depth for accurate ICD-10 coding (L97).
  • Ensure CDI captures ulcer etiology: arterial, venous, diabetic, pressure (I70, I83).
  • Offload pressure: use appropriate footwear, padding to promote healing, prevent recurrence.
  • Monitor, document wound care, debridement, infection signs for compliance, billing (97597-97602).
  • Optimize vascular assessment, management for arterial ulcers. Improves outcomes, coding (I70).

Clinical Decision Support

Checklist
  • Confirm ulcer location on toe: Document specific toe and surface.
  • Assess ulcer characteristics: Size, depth, exudate, tissue type.
  • Evaluate for infection signs: Erythema, warmth, pain, purulence.
  • Check pedal pulses: Assess vascular status (Doppler if needed).

Reimbursement and Quality Metrics

Impact Summary
  • Ulcer on Toe: Coding accuracy impacts reimbursement for debridement, non-excisional skin procedures.
  • Proper ICD-10 coding (L97, L89) for toe ulcers affects hospital quality reporting on wound care.
  • Accurate documentation of ulcer stage, size, and infection status impacts appropriate level E/M coding, affecting RVUs.
  • Specificity in coding ulcer etiology (diabetic, pressure, arterial) influences quality metrics for population health management.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Specify ulcer location on toe
  • Document ulcer stage and size
  • Code underlying cause of ulcer
  • Consider L97 for non-pressure ulcers
  • Add 7th character for laterality

Documentation Templates

Patient presents with a toe ulcer, consistent with a digital foot ulcer.  The location of the ulcer is documented on the foot diagram.  The patient reports [onset duration] of [pain quality, e.g., throbbing, burning, aching] pain at the ulcer site, exacerbated by [exacerbating factors, e.g., pressure, ambulation, elevation].  Visual examination reveals a [size] cm ulcer on the [toe number, e.g., first, second] toe, with [ulcer base description, e.g., a fibrinous base, granulation tissue, necrotic tissue].  The surrounding skin exhibits [periwound skin description, e.g., erythema, edema, induration, callus formation].  Peripheral pulses are [palpable or non-palpable].  Capillary refill time is [time] seconds.  Neuropathy assessment via monofilament testing reveals [sensory status, e.g., intact sensation, diminished sensation, absent sensation].  Assessment includes diabetic foot ulcer, venous stasis ulcer, arterial ulcer, pressure ulcer, and neuropathic ulcer.  Differential diagnosis considers the patient's medical history, including [relevant medical history, e.g., diabetes, peripheral arterial disease, venous insufficiency, history of trauma].  Plan includes [wound care plan, e.g., debridement, dressings, offloading], [vascular assessment if indicated], and [pain management plan].  Patient education provided regarding ulcer care, offloading techniques, and the importance of regular follow-up appointments.  ICD-10 code [relevant ICD-10 code, e.g., L97.419, I70.24, I83.119] is considered based on the clinical presentation.  Follow-up scheduled in [duration] for wound reassessment and evaluation of treatment response.
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