december 2010
Informative and educational updates for providers
FOCUS ON: pressure ulcers
Pressure ulcers are lesions caused by unrelieved pressure that
results in damage to the underlying tissue.1,2 Generally, these
are the result of soft tissue compression between a bony
prominence and an external surface for a prolonged period of
time. The consequences of pressure-induced skin injury range
from erythema of skin to deep ulcers extending to the bone.
The prevalence pressure ulcers may be more widespread than
initially thought particularly as the number of vulnerable elderly
patients increases;3 it is estimated that over three million
Americans may have pressure ulcers at a health system cost
ranging from $1,000 to $40,000 in addition to the pain and
suffering endured by the patient.4 There are two scales used
frequently to assess the risk of pressure ulcer: the Norton
Scale and the Braden Scale.
RISK FACTORS BASED ON THE BRADEN SCALE5
• Inability to sense or respond to discomfort related to
pressure (e.g. unresponsive or reduced responsiveness)
• Exposure to moisture, such as urine or perspiration
• Inactivity, such as bed or chair confinement
• Restricted ability to change positions (e.g. limited or no mobility)
• Poor nutritional status
• Increased exposure to friction and shear, such as sliding against bed sheets, chair or restraints
DESCRIPTIONS OF STAGING6
Stage I: Non-blanching erythema
Stage II: Abrasion, blister, shallow open crater, or other
partial thickness skin loss
Stage III: Full thickness skin loss involving damage or
necrosis into subcutaneous soft tissues
Stage IV: Full thickness skin loss with necrosis of soft
tissues through to the muscle, tendons or tissues around
underlying bone
Unstageable: Lesion inaccessible for evaluation due
to non-removable dressings, eschar, sterile blister and
suspected deep injury in evolution
The information presented herein is for informational purposes only. It is not intended, nor is it to be
used, to define a standard of care or otherwise substitute for informed medical evaluation, diagnosis and
treatment which can only be performed by a qualified medical professional. Ingenix, Inc. does not warrant
or represent that the information contained herein is accurate or free from defects.
This information is for informational purposes only and does not replace the professional judgment and
expertise of the individual performing coding based on numerous factors including, but not limited to,
documentation in the medical record and other industry recognized coding guidance. Because codes,
coding requirements and standards can and do change, the individual assigning codes is reminded to
verify the accuracy, specificity, currency and acceptability of such codes and coding methods used.
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© Ingenix 2010
Always…
• Document both the site and the stage of the pressure
ulcer.
• Code both the site and the stage of the pressure ulcer
even if the stage is not specified, see below.
• Document as “ulcer” and not as “wounds,” “open wounds”
or “lesions”.
Documentation and Coding Tips7
Synonymous terms for a pressure ulcer may include
decubitus ulcer, bed sore or plaster ulcer.
707.00-707.07, 707.09 identifies the site of the pressure
ulcer:
707.00 Unspecified site
707.01 Elbow
707.02 Upper back, shoulder blades
707.03 Lower back, coccyx, sacrum
707.04 Hip
707.05 Buttock
707.06 Ankle
707.07 Heel
707.09 Other site, head
707.20-707.25 identifies the stage of the pressure ulcer:
707.20 Unspecified stage
707.21 Stage I
707.22 Stage II
707.23 Stage III
707.24 Stage IV
707.25 Unstageable
Coding Example*
Assessment: Decubitus ulcer of sacrum, stage III
Code for Site:
707.03 Pressure ulcer lower back, coccyx, sacrum
Code for Stage:
707.23 Pressure ulcer stage III
*The example presented is only a portion of a comprehensive
progress note, which must include evaluative language which
supports the assessment, in addition to a plan of care.
1 Thomas, DR. The new F-tag 314: prevention and management of pressure ulcers. J Am Med
Dir Assoc 2006; 7:523
2 Pressure ulcers prevalence, cost and risk assessment: consensus development conference
statement--The National Pressure Ulcer Advisory Panel. Decubitus 1989; 2:24
3 Lyder, CH. “Pressure Ulcer Prevention and Management.” JAMA 2003;289(2):223-226
4 Vangilder, C, et al. “Result of Nine International Pressure Ulcer Prevalence Surveys: 19892005.” Ostomy Wound Manage 2008;54(2):40-54
5 Bates-Jensen, BM. “Quality Indicators for Prevention and Management of Pressure Ulcers in
Vulnerable Elders.” Annals of Internal Medicine 2001;135:744-751
6 Coders’ Desk Reference for Diagnoses, 2011. Alexandria, VA: Ingenix, 2010.
7 World Health Organization, Professional: ICD-9-CM for Physicians-Volumes 1&2.
2011. Alexandria, VA: Ingenix, 2010.
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