Coding Deep Pressure-Induced Tissue Damage in FY2020

Coding Deep Pressure-Induced Tissue Damage in FY2020

Clinicians will soon be able to better identify and track deep pressure-induced tissue damage in their patients for surveillance and quality improvement purposes. Several new ICD-10-CM codes under category L89 Pressure ulcer clear up the confusion that was created between the diagnosis code set and promulgated clinical literature after the National Pressure Ulcer Advisory Panel (NPUAP) updated in 2016 the stages of pressure injury.

In the previous staging system, Stage 1 and deep tissue injury described injured intact skin, while the other stages described open ulcers. According to the NPUAP, this led to confusion because the ICD-10-CM definitions for each of the stages referred to the injuries as “pressure ulcers.” The new codes expressly state “pressure-induced deep tissue damage.”

What Is the Definition of a Pressure Injury?

Pressure injury is now described as “localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue.”

What is the Definition of a Deep Tissue Injury?

Deep tissue injury is now defined as “intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister. Pain and temperature change often precedes skin color changes. Discoloration may appear differently in darkly pigmented skin. This condition results from intense and/or prolonged pressure and shear forces at the bone-muscle interface. The wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss.”

Coding Deep Tissue Injuries

“Deep tissue injury” is indexed to Ulcer, pressure, unstageable, and then by site. “However,” the Agency for Healthcare Research and Quality reasoned at the ICD-10 Coordination and Maintenance Committee meeting on Sept. 12, 2018, “unstageable ulcers can ONLY be Stage 3 or 4 by definition (‘full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar. If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed.’). By contrast, deep tissue injury may resolve without tissue loss. In addition, deep tissue injuries often have a combined etiology involving both ischemia and pressure.”

As a result of the AHRQ’s request, several new codes for deep pressure-induced tissue damage go into effect Oct. 1, 2019. Take note, as the new codes will change pressure ulcer and non-pressure ulcer ICD-10 coding.

ICD-10-CM Codes for Fiscal Year 2020

L89.116Pressure-induced deep tissue damage of right upper back
L89.126Pressure-induced deep tissue damage of left upper back
L89.136Pressure-induced deep tissue damage of right lower back
L89.146Pressure-induced deep tissue damage of left lower back
L89.156Pressure-induced deep tissue damage of sacral region
L89.206Pressure-induced deep tissue damage of unspecified hip
L89.216Pressure-induced deep tissue damage of right hip
L89.226Pressure-induced deep tissue damage of left hip
L89.306Pressure-induced deep tissue damage of unspecified buttock
L89.316Pressure-induced deep tissue damage of right buttock
L89.326Pressure-induced deep tissue damage of left buttock
L89.46Pressure-induced deep tissue damage of contiguous site of back, buttock and hip
L89.506Pressure-induced deep tissue damage of unspecified ankle
L89.516Pressure-induced deep tissue damage of right ankle
L89.526Pressure-induced deep tissue damage of left ankle
L89.606Pressure-induced deep tissue damage of unspecified heel
L89.616Pressure-induced deep tissue damage of right heel
L89.626Pressure-induced deep tissue damage of left heel
L89.816Pressure-induced deep tissue damage of head
L89.896Pressure-induced deep tissue damage of other site
L89.96Pressure-induced deep tissue damage of unspecified site

Look for updates to Medicare Administrative Contractors’ affected local coverage determinations shortly after the new codes are implemented by the Centers for Medicare & Medicaid Services.

Renee Dustman

Renee Dustman

Executive Editor at AAPC

Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications – Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

Renee Dustman

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