E11.621
BillableType 2 diabetes mellitus with foot ulcer
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
Type 2 diabetes resulting in an open sore or wound on the foot that fails to heal properly.
Coding Tips
- •Always specify the location and severity of the foot ulcer using additional codes if available
- •Document whether the ulcer is infected, as this affects treatment and coding specificity
Clinical Significance
Type 2 diabetes mellitus with foot ulcer is one of the most clinically significant diabetic complications, representing the primary pathway to non-traumatic lower extremity amputation. Diabetic foot ulcers develop from the convergence of peripheral neuropathy (loss of protective sensation), peripheral arterial disease (impaired blood flow), and foot deformity (abnormal pressure distribution). Annual incidence in diabetic patients is 2-5%, with lifetime risk as high as 25%.
Documentation Requirements
- ✓Documentation must specify a foot ulcer in a Type 2 diabetic patient, including precise anatomical location (heel, midfoot, forefoot, toe), ulcer dimensions, depth classification (Wagner grade or University of Texas classification), and presence of infection or exposed structures.
- ✓An additional L97 code must be assigned for ulcer site and severity specificity.
- ✓Vascular assessment, neuropathy evaluation, and wound care plan should be documented.
Commonly Confused Codes
E11.622 (other skin ulcer) is for non-pedal ulcer locations.E11.52 (peripheral angiopathy with gangrene) indicates tissue death beyond ulceration.L97.4-L97.5 (non-pressure chronic ulcer of foot) are required additional codes for site specificity.E11.620 (diabetic dermatitis) covers inflammatory skin conditions without ulceration.