Last year’s wound care webinars dove into the proper coding of wound care and offered several resources.  We received so many fantastic follow-up questions that we felt it would be best to share and elaborate on them in another webinar.  Questions surrounding underlying conditions seem to weigh heaviest on coders.

To understand the healing process of an ulcer, it’s often helpful to understand the etiology of ulcers.  It’s very rare that ulcers develop for no reason.  If there isn’t an original insult in the skin such as a laceration or puncture wound, a disease process is most often the culprit.  We all know there is a direct correlation between diabetes and ulcers.  What coders may not know is there is a significant connection between venous blood flow and ulcers.

Let’s think for a moment about the circulatory system.  Take yourself back to high school science class when you were learning about veins and arteries.  You may recall that arteries are muscular vessels that carry oxygen-rich blood away from the heart to the body.  Veins return the deoxygenated blood back to the heart to be reoxygenated.   Veins are the unsung heroes of the circulatory system.  They don’t have the strong, muscular make up that arteries do and they also don’t have the heart behind them pumping the blood, against gravity, back to the lungs.  In fact, they need valves to keep blood flowing in the right direction, towards the heart.  Ulcers can happen when something goes wrong with the veins or valves in the legs.

If the veins or their valves fail and are unable to get the deoxygenated blood back to the heart, the blood will start to seep out into the extremities.  This is called venous insufficiency.  Now we have unoxygenated, nutrient-deprived blood and various fluids filling the lower extremities.  Swelling or edema will develop, and open wounds may form.  In a body with normal veins, this open wound would heal quickly but in a patient with venous insufficiency, an open wound can quickly become a non-healing ulcer.

Often, the first part of treating an ulcer is determining the underlying cause.  This will also direct the provider to create the best treatment plan for the patient, often treating both the underlying venous issue and the ulcer simultaneously.

In part 3 of the wound care trilogy, we’ll talk about those underlying or secondary conditions that may potentially cause and inhibit a wound to heal properly.  We’ll work through several wound care case studies utilizing handy references provided to us by Coding Clinic.  Finally, we’ll showcase many of the questions we received after the last 2 webinars and highlight various Coding Clinics that are out there.  The webinar will be “on-demand” only, so register now and watch in your free time!

Terri Reid, CCS, CCS-P, CDIP, AHIMA-Approved ICD-10-CM/PCS Trainer

Terri Reid, CCS, CCS-P, CDIP, AHIMA-Approved ICD-10-CM/PCS Trainer

Senior Coding Quality Auditor

Terri comes to Haugen Group with 20+ years of health information management experience in coding, auditing, and education.    She began her career coding emergency room records and wound care records where she helped develop coding and E/M protocols and met with the providers to help them improve their documentation.  Terri transitioned to an auditing role when she realized how much she enjoyed sharing her coding knowledge and experiences with other coders to help improve their skills and confidence. Terri brings her expertise in coding and auditing to the Haugen Consulting Group, having worked in previous roles leading and performing inpatient and outpatient coding audits.  She is passionate about learning new medical technology and how the disease process affects illnesses.


  1. Kim Sterling

    Wound #10 Right, Medial Second Toe is a chronic Wagner Grade 1 Diabetic Ulcer and has received a status of Not Healed. Subsequent wound encounter measurements are 0.4cm length x 0.3cm width with no measurable depth, with an area of 0.12 sq cm

    Which of the following is used to represent ” no measurable depth”

    skin breakdown only
    fat layer exposed
    muscle involvement w/o necrosis
    muscle necrosis
    bone involvement w/o necrosis
    bone necrosis
    other specified

    • kkluglein

      Hi Kim,

      Great question! “No measurable depth” does not fall into unspecified (it is, indeed specified). It also does not fall into any of the actual depths, so our team would recommend “other specified”.

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