Venous Stasis Ulcers

Good morning Listers!!!

I have a question I was hoping one of our more surgical coders could help me with......

Can anyone explain to me why CPT 11042 LCD L34587 Wound Care doesn't include the diagnosis for venous stasis ulcers?? Every other type of ulcer is listed even varicose veins are listed. I thought there must be a clinical reason that particular type of ulcer is excluded??

What do you all think??

Carol J. Self, CPPM, CPC, EMT


  • Carol, did you notice there's additional pages of diagnoses in the LCD for CPT 11042? The I83.XXX codes are in there to describe the varicose veins with ulcer, along with the non-pressure chronic ulcer codes L97.XXX to describe further.


    Kris Cuddy, CPC, CIMC
    Healthcare Compliance Analyst
    Compliance Office
    Michigan State University HealthTeam
    East Lansing, MI
    Ofc: 517-355-4547
    Fax: 517-353-5292

  • edited May 2017

    I am always interested in the clinical reasons for inclusion/exclusion of certain reasons for insurance plan coverage.

    I found this and believe it helped me to understand why venous stasis ulcer isn't on the list, but the real answer would come from the carrier who wrote the LCD.

    Karen A. Hurley, BS, CMM, CPC, CNA
    President, HPMSI
    PO Box 409
    Parrish, FL 34219-0409
    Tel: (941) 776-4822
    Fax: (240) 368-0059

    Since 1996, Celebrating 20 years of Service to Physicians

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