Perspectives in Circulation Today

ICD-9-CM Codes for Circulatory Disorders
of the Lower Extremity
Potentially Useful in Circulator Boot Clinics

Gangrene and Arteriosclerosis

• 785 Symptoms involving cardiovascular system
  785.4 Gangrene
  
  Gangrene:
  NOS Gangrenous cellulitis
  Phagedena
  Code first any associated underlying condition
  Excludes:
  gangrene with atherosclerosis of the extremities (440.24)
  gas gangrene (040.0)

• 440.2 Of native arteries of the extremities
  440.24 Atherosclerosis of the extremities with gangrene
  Any condition classifiable to 440.21, 440.22, and 440.23 with ischemic gangrene 785.4
  Use additional code for any associated ulceration (707.10-707.9)
  Excludes:
  gas gangrene 040.0

• 250 Diabetes mellitus
  250.7 Diabetes with peripheral circulatory disorders
  Use additional code to identify manifestation, as diabetic:
  gangrene (785.4)
  peripheral angiopathy (443.81)

Osteomyelitis and Cellulitis

• 040 Other bacterial diseases
  040.0 Gas gangrene
  Gas bacillus infection or gangrene
  Infection by Clostridium:
  
  histolyticum
  oedematiens
  perfringens [welchii]
  septicum
  sordellii
  Malignant edema
  Myonecrosis, clostridial
  Myositis, clostridial
  
• 730 Osteomyelitis, periostitis, and other infections involving bone
  730.0 Acute osteomyelitis
  [0-9]
  Abscess of any bone except accessory sinus, jaw, or mastoid
  Acute or subacute osteomyelitis, with or without mention of periostitis
  Use additional code to identify major osseous defect, if applicable (731.3)
  
• 731 Osteitis deformans and osteopathies associated with other disorders classified elsewhere
  731.8 Other bone involvement in diseases classified elsewhere
  Code first underlying disease, as:
  diabetes mellitus (250.8)
  Use additional code to specify bone condition, such as:
  acute osteomyelitis (730.00-730.09)
  

Ulcers Of Skin

• 707 Chronic ulcer of skin
  707.1 Ulcer of lower limbs, except decubitus
  Ulcer, chronic, of lower limb:
  
  neurogenic of lower limb
  trophic of lower limb
  Code, if applicable, any causal condition first:
  atherosclerosis of the extremities with ulceration (440.23)
  chronic venous hypertension with ulcer (459.31)
  chronic venous hypertension with ulcer and inflammation (459.33)
  diabetes mellitus (250.80-250.83)
  postphlebitic syndrome with ulcer (459.11)
  postphlebitic syndrome with ulcer and inflammation (459.13)
  
  707.10 Ulcer of lower limb, unspecified
  707.11 Ulcer of thigh
  707.12 Ulcer of calf
  707.13 Ulcer of ankle
  707.14 Ulcer of heel and midfoot
  Plantar surface of midfoot
  707.15 Ulcer of other part of foot
  Toes
  707.19 Ulcer of other part of lower limb
  707.8 Chronic ulcer of other specified sites
  Ulcer, chronic, of other specified sites:
  neurogenic of other specified sites
  trophic of other specified sites
  707.9 Chronic ulcer of unspecified site
  
  Chronic ulcer NOS
  Trophic ulcer NOS
  Tropical ulcer NOS
  Ulcer of skin NOS
  
• 454 Varicose veins of lower extremities
  454.2 With ulcer and inflammation
  Varicose veins with ulcer and inflammation of lower extremity [any
  part] or of unspecified site
  Any condition classifiable to 454.9 with ulcer and inflammation
  

Peripheral Arteriosclerosis
Claudication and Rest Pain

• 440.2 Of native arteries of the extremities
  440.21 Atherosclerosis of the extremities with intermittent claudication
  440.22 Atherosclerosis of the extremities with rest pain
  Any condition classifiable to 440.21
  
• 443 Other peripheral vascular disease
  443.9 Peripheral vascular disease, unspecified
  Intermittent claudication NOS
  Peripheral:
  
  angiopathy NOS
  vascular disease NOS
  Spasm of artery
  Excludes:
  
  atherosclerosis of the arteries of the extremities (440.20-440.22)
  spasm of cerebral artery (435.0-435.9)
  

Congestive Heart Failure

• 428.0 Congestive heart failure, unspecified
  Congestive heart disease
  Right heart failure (secondary to left heart failure)
  Excludes:
  fluid overload NOS (276.6)
  
• 398.91 Rheumatic heart failure (congestive)
  Rheumatic left ventricular failure
  
• 428.1 Left heart failure
  Acute edema of lung with heart disease NOS or heart failure
  Acute pulmonary edema with heart disease NOS or heart failure
  Cardiac asthma
  Left ventricular failure
  
• 428.9 Heart failure, unspecified
  Cardiac failure NOS
  Heart failure NOS
  Myocardial failure NOS
  Weak heart
  
• 428.2 Systolic heart failure
  Excludes:
  combined systolic and diastolic heart failure (428.40-428.43)
  
• 428.3 Diastolic heart failure
  Excludes:
  combined systolic and diastolic heart failure (428.40-428.43)
  
• 402 Hypertensive heart disease
  Includes:
  hypertensive:
  
  cardiomegaly
  cardiopathy
  cardiovascular disease
  heart (disease) (failure)
  any condition classifiable to 429.0-429.3, 429.8, 429.9 due to
  hypertension
  Use additional code to specify type of heart failure (428.0-428.43), if
  known
  
• 428 Heart failure
  Code, if applicable, heart failure due to hypertension first (402.0-
  402.9, with fifth-digit 1 or 404.0-404.9 with fifth-digit 1 or 3)
  Excludes:
  
  rheumatic (398.91)
  that complicating:
  
  abortion (634-638 with .7, 639.8)
  ectopic or molar pregnancy (639.8)
  labor or delivery (668.1, 669.4)
  

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  Lymphedema

• 457 Noninfectious disorders of lymphatic channels
  457.0 Postmastectomy lymphedema syndrome
  
  Elephantiasis due to mastectomy
  Obliteration of lymphatic vessel due to mastectomy
  
  757.0 Hereditary edema of legs
  
  Congenital lymphedema Hereditary trophedema Milroy's disease
  457.1 Other lymphedema
  Elephantiasis (nonfilarial) NOS
  Lymphangiectasis
  Lymphedema:
  
  acquired (chronic)
  praecox
  secondary
  Obliteration, lymphatic vessel
  Excludes:
  
  elephantiasis (nonfilarial):
  congenital (757.0)
  eyelid (374.83)
  vulva (624.8)
  

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  586 Renal Failure, unspecified

  Includes:
  Uremia NOS
  Excludes:
  
  following labor and delivery (669.3)
  posttraumatic renal failure (958.5)
  that complicating:
  abortion (634-638 with .3, 639.3)
  ectopic or molar pregnancy (639.3)
  uremia:
  extrarenal (788.9)
  prerenal (788.9)
  with any condition classifiable to 401 (403.0-403.9 with fifth-digit 1)
  

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  Examples of “Pressure” Ulcers

  Under current regulations, providers must first select a code that
  corresponds to the site of the pressure ulcer and then select a code
  that represents its stage. Thus, from the charts below, code 707.06,
  pressure ulcer ankle; code 707.23 pressure ulcer, stage III would be
  chosen to report a stage III pressure ulcer of the ankle. In addition,
  to coding the location and severity of a pressure ulcer, the hospital
  provider should provide a code declaring whether or not the ulcer was
  present before the order to admit the patient to the hospital or
  whether the ulcer developed after admission, an event CMS has
  determined should never happen with appropriate preventive care. CMS
  does not pay for “HAC’s” (hospital acquired conditions). Thus, a “POA”
  is attached to the principal and secondary diagnoses as follows:
  • “Y” = Present at time of inpatient admission
  • “N” = Not present at time of inpatient admission
  • “U” = Documentation insufficient to determine if ulcer preexisted admission
  • “W” = Provider unable to determine clinically if ulcer POA
  • “ 1” = Exempt from POA reporting
  

  Historically, pressure ulcers of the extremities were considered to be
  complications or comorbidities (CC’s) when they were listed as a
  secondary diagnosis. CMS now continues the CC system with a 3-tiered
  classification:
  • “MCC” = MS DRG with major complication or comorbidity
  • “CC” = MS DRG with complication or comorbidity
  • “w/o MCC/CC” = no complication or comorbidity
  

• MCC (Highest reimbursement category):
  
  707.23 Pressure ulcer, Stage III
  707.24 Pressure ulcer, Stage IV
  
• CC (Reimbursement higher than w/o MCC/CC):
  
  707.10 Unspecified ulcer of lower limb
  707.11 Ulcer of thigh
  707.12 Ulcer of calf
  707.13 Ulcer of ankle
  707.14 Ulcer of heel and midfoot
  707.19 Ulcer of other part of lower limb
  
• Codes w/o MCC/CC:
  
  707.00 Pressure ulcer, unspecified site
  707.01 Pressure ulcer, elbow
  707.02 Pressure ulcer, upper back
  707.03 Pressure ulcer, lower back
  707.04 Pressure ulcer, hip
  707.05 Pressure ulcer, buttock
  707.06 Pressure ulcer, ankle
  707.07 Pressure ulcer, heel
  707.09 Pressure ulcer, other site
  707.20 Pressure ulcer, unspecified stage
  707.21 Pressure ulcer, Stage I
  707.22 Pressure ulcer, Stage II
  707.25 Pressure ulcer, unstageable
  

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  Perspectives in Circulation Today

  Volume 3, Number 9

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