ICDxICD-10 Medical Coding

ICDxICD-10 Medical Coding

ICD-10 Guide

Arterial Ulcer

ICD-10 Coding for Arterial Ulcer(I70.23, L97.411)

PRIMARY SPECIALTYVascular Surgery

COMPLEXITYHigh

LAST UPDATED09/15/2025

Sam Tuffun, PT, DPT

Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Arterial Ulcer?

Essential facts and insights about Arterial Ulcer

Key Clinical Considerations:

Presence of ischemic ulcers typically located on the toes, feet, or lower legs, often with a pale or necrotic appearance.
Ankle-brachial index (ABI) less than 0.9 indicating peripheral artery disease.
Physical examination may reveal diminished or absent pulses in the affected limb.
Imaging studies such as Doppler ultrasound may show reduced blood flow in the affected arteries.
Severity can be staged based on the Wagner classification, ranging from superficial ulcers to deep tissue loss.

Clinical Information

Clinical Criteria & Documentation Requirements

Complete patient history including risk factors such as diabetes, smoking, and hypertension.
Use of specific terminology such as 'ischemic ulcer' or 'arterial ulcer' must be documented.
Examples include: 'Patient presents with a non-healing ulcer on the right foot consistent with arterial insufficiency.'
Documentation must demonstrate medical necessity for interventions such as wound care or surgical procedures.
Quality measures may include documentation of ABI results and ulcer staging.

Coding Guidelines

Usage Guidelines & Examples

Use I70.23 for arterial ulcers due to peripheral vascular disease; use L97.411 for non-healing ulcers due to other causes.
Do not use I70.23 for venous ulcers or diabetic ulcers as they have distinct coding.
Compare with I70.21 (Atherosclerosis of native arteries of the extremities) for related conditions.
Common errors include misclassifying the ulcer type; ensure accurate assessment of etiology.
In complex cases, consider co-morbid conditions and document all relevant factors influencing the ulcer.

Code Exclusions

Important Exclusions

Do not code I70.23 for ulcers caused by venous insufficiency or pressure ulcers.
Use L97 codes for non-arterial ulcers to avoid misclassification.
Conditions are excluded to ensure accurate representation of the underlying pathology.
Common mistakes include using arterial ulcer codes for diabetic foot ulcers without proper documentation.
Related conditions such as venous ulcers (I83.00) should be distinctly coded.

Specialty Focus

Primary Specialty

Vascular Surgery

Specialty Applications

Patients with peripheral artery disease, diabetes, or a history of smoking.
Typically affects older adults, particularly those over 65 years of age.
Clinical settings include outpatient wound care clinics, inpatient vascular surgery units, and emergency departments.
Relevant for vascular surgery specialists, wound care specialists, and primary care providers.
Used in treatment contexts involving surgical intervention, advanced wound care, and rehabilitation.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

Comprehensive clinical documentation
Accurate code selection based on clinical criteria
Proper exclusion considerations
Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with arterial ulcer based on clinical findings of ischemia.'

Template 2

Template: 'Clinical presentation consistent with arterial ulcer including pain and necrosis.'

Template 3

Template: 'Diagnostic criteria met as evidenced by ABI of 0.7 and ulceration on the foot.'

Template 4

Template: 'Treatment plan initiated for arterial ulcer with debridement and vascular assessment.'

Template 5

Template: 'Follow-up care for arterial ulcer including monitoring of healing progress and ABI.'

Billing Information

Billing Considerations

Ensure proper documentation for billing
Verify code specificity requirements
Check for any additional codes needed
Review payer-specific guidelines

Common Issues

Insufficient clinical documentation
Incorrect code selection
Missing supporting diagnoses
Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Document clinical findings, risk factors, and treatment plans clearly.

How does this differ from similar diagnoses?

Arterial ulcers are ischemic, while venous ulcers are related to venous insufficiency.

What are common billing considerations?

Ensure medical necessity is documented to support claims for treatment.

What procedures are typically associated?

CPT codes for debridement, vascular surgery, and wound care may apply.

Are there any quality reporting implications?

Monitor quality measures related to ulcer healing rates and patient outcomes.