01/16/2019

Billing for Wagner Grade 3 Ulcer with Osteomyelitis and Abscess

I have a patient with a Wagner Grade 3 ulcer. Left 2nd toe with dimensions 2 x 2 x 0.3 cm with known osteomyelitis(as per Xray) and abscess. This was debrided. L97.522 Diagnosis. How is this billed? Is 11042 appropriate?

Based on the documentation from the radiologist, CPT 11042 is an accurate procedure code based on the square footage of the wound since it does not affect the deep muscle or bone. The primary diagnosis of L97.522 is appropriate based on what you stated is documented of the wound appearance and measurements. With the detail from the x-ray, add a secondary diagnosis of acute osteomyelitis billed under ICD-10 code M86.18 (other acute osteomyelitis, other site) since you also stated osteomyelitis. No additional diagnosis codes or modifiers are required to bill to the patient’s insurance.