03/09/2026    David J. Freedman, DPM

Pressure Ulcers Underneath the Toes

If a potential patient has (non-blanchable
erythema with dried up bleeding underneath the
distal plantar aspect of a hammertoe, with an
intact epidermis should a podiatrist avoid the
ICD-10 code L89.611 for an evaluation and
management service if the epidermis is intact?

The dermis might have been penetrated. If a corn
or callus has bleeding inside the epidermis, is
this coded using l84 with a secondary diagnosis of
hammertoe M20.41 / M20.42 ? Do you use an
evaluation and management service if off-loading
is provided and/or discussed and the chart states
non-blanchable erythema with intact skin that did
not fully penetrate the epidermis?

PM News Subscriber

Response: If your examination documents non-
blanchable erythema with intact skin that has not
penetrated the epidermis, this meets the
definition of a Stage 1 pressure injury. The
correct code would be: ICD-10-CM L89.611 —
Pressure ulcer of right heel, stage 1 (Includes
terms such as healing Stage 1 pressure ulcer and
pressure-related skin changes limited to
persistent focal edema of the right heel.) You
would not assign L84 (corns and callosities) based
on the description you provided, as that code does
not reflect pressure-induced tissue injury.

Clarification Regarding “Bleeding Inside the
Epidermis”. If there is documentation of bleeding
within the tissue, coding depends on the clinical
description: If it represents traumatic injury ?
it may be classified as a contusion.

If there is obscured depth due to tissue damage ?
it may be considered an unstageable pressure
injury, depending on the documentation. Hammertoe
Deformities. If the patient has hammertoe
deformities: If the hammertoes are the underlying
cause of the pressure and resulting skin changes,
they may be reported as the primary diagnoses,
with the pressure injury as secondary. M20.41 —
Other hammertoe(s) (acquired), right foot and
M20.42 — Other hammertoe(s) (acquired), left foot
Medical Management. Proper off-loading and
footwear modification are key to preventing
progression of the injury.

Treatment typically focuses on off-loading
pressure from the affected area and may include
any of the following: Foam padding, crest pads,
Silicone toe caps, Sandals or extra-depth shoes
with digital padding, Custom orthotics if needed,
Medication if inflammation, infection, or pain is
present.

David J. Freedman, DPM, Silver Spring, MD

There are no more messages in this thread.