I83.211
BillableVaricose veins of right lower extremity with both ulcer of thigh and inflammation
HCC Category Mapping
What This Code Means
Enlarged veins in the right lower leg with an open sore on the thigh and swelling.
Coding Tips
- •Confirm laterality is documented as right leg before assigning this code
- •Verify the ulcer is specifically located on the thigh rather than other leg locations
Clinical Significance
Varicose veins with both ulceration and inflammation represent advanced chronic venous insufficiency requiring ongoing wound management and vascular monitoring. The combination of ulceration and inflammation indicates significant tissue compromise from chronic venous hypertension, increasing the risk of infection, cellulitis, and delayed wound healing. This diagnosis signals the need for compression therapy, wound care, and potential surgical intervention to prevent further deterioration.
Documentation Requirements
- ✓Documented diagnosis of varicose veins of the lower extremity
- ✓Laterality clearly specified (left lower extremity)
- ✓Ulcer location documented (thigh)
- ✓Presence of BOTH ulceration AND inflammation explicitly stated
- ✓Description of ulcer characteristics (size, depth, drainage, wound bed)
- ✓Signs of inflammation documented (erythema, warmth, edema, tenderness)
- ✓Current treatment plan for wound management and venous insufficiency
- ✓Assessment of whether condition is new, worsening, or stable