Providers should review their protocols to prepare for the changes.
The 2020 updates to ICD-10-CM contain some significant changes to Chapter 12, Diseases of the Skin and Subcutaneous Tissue. These changes include the addition of new codes for the reporting of pressure-induced deep-tissue damage, also known as deep-tissue pressure injury (DTPI), and a new chapter-specific guideline that provides direction on how these codes are assigned.
What is Pressure-Induced Deep-Tissue Damage?
Pressure-induced deep-tissue damage is a serious form of pressure ulcer caused by direct pressure to the skin and soft tissue that causes ischemia. The injury is characterized by purple or maroon areas of intact skin. These injuries can also present as blood blisters. Because they form in deep tissue, these ulcers may not be visible until they are far advanced, and they may be harder to recognize in patients with darker skin tone. Associated symptoms include pain at the site of compromised tissue, and differences in tissue consistency or temperature when compared to adjacent tissue.
The Codes
The codes for pressure-induced deep-tissue injury are found in the L89, Pressure Ulcer code category. Codes in this category have a fifth or sixth character that identifies the pressure ulcer’s stage. Previously, coding guideline I.C.12.a.2 directed that these injuries also be reported with a fifth or sixth character representing an unstageable pressure ulcer. The updates introduce a new fifth or sixth character of “6” to specifically classify instances of pressure-induced deep-tissue injury.
Example: L89.016 Deep tissue pressure injury of right elbow
The Guidelines
ICD-10-CM 2020 contains a new guideline directing how codes for deep-tissue pressure injury are to be assigned, as outlined below:
I.C.12.a.7 Pressure-Induced Deep-Tissue Damage
“For pressure-induced deep-tissue damage or deep-tissue pressure injury, assign only the appropriate code for pressure-induced deep-tissue damage (L89.- -6).”
The direction in the new guideline means that it is inappropriate to assign codes that report unstageable pressure ulcers, or pressure ulcers classified as stage 1-4, for a diagnosis of pressure-induced deep-tissue damage or deep-tissue pressure injury.
Guideline I.C.12.a.2 has also been edited to remove the guidance directing a code for unstageable pressure ulcer for documentation of deep-tissue pressure injury.
Codes for deep-tissue pressure injury are classified alongside the other codes in the L89 category. This means that all guidelines pertaining to the coding of pressure ulcers apply to these codes as well.
What Does This Mean for My Organization?
Because documentation sometimes lacks specificity, coders should be educated about the clinical indicators that suggest the presence of deep-tissue pressure injury to allow them to recognize when a query for this condition is appropriate.
Clinical indicators on which to educate coders include:
The introduction of new codes signals the need for organizations to review the code choices available in their electronic health records. Options for these new codes should be added to the appropriate dropdown menus or pick lists in order for each facility to capture its rate of occurrence for statistical and quality reporting purposes.
The addition of these codes to the electronic health record (EHR) should be brought to the attention of physicians and CDI specialists so they don’t continue to assign the now-inappropriate codes for unstageable pressure ulcers, simply out of routine or habit.
Recap
Visit the link below for a short overview of the pertinence of and a summary of the new codes, as provided by the National Pressure Ulcer Advisory Panel.
https://npiap.com/news/news.asp?id=462845
Programming Note:
Listen to Cari Greenwood during today’s live edition of Talk Ten Tuesday, 10-10:30 a.m. EST.
Coding in the post-acute care world has taken on a new significance in the past five years. For those of us who are coders, this
EDITOR’S NOTE: With Halloween on the radar, ICD10monitor Contributor Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for the St. Louis-based First
Please log in to your account to comment on this article.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
