Appropriate ICD-10 Coding Transition for Non-Healing Traumatic Wounds

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In cases where a wound is initially classified under an "A" code (e.g., S31.114A – Laceration without foreign body of abdominal wall, left lower quadrant), should the etiology and corresponding ICD-10 coding remain consistent throughout the course of treatment until resolution?
For instance, if the patient presents with a traumatic laceration that has failed to heal after 6 weeks, would it then be appropriate to update the diagnosis to a chronic wound code, such as L98.495 – Chronic ulcer of skin with muscle involvement without evidence of necrosis, to reflect its chronic non-healing status and clinical presentation?

If a change in coding is warranted, at what point during the wound's progression should this transition from an acute injury code to a chronic ulcer code typically occur?

Apr 21, 2025 by Dominic Santiago, LVN

2 replies

Kim Simonson
RN-BC, ACHRN, CWS, FACCWS

Hi Dominic,

Thank you for your question.

The quick answer is yes — a traumatic wound that does not heal within the expected timeframe may become a chronic wound and can be coded as such. The definition of a chronic, non-healing ulcer or wound varies, but generally refers to one that has not healed within 4–12 weeks. It is a wound that fails to progress through the normal phases of healing in an orderly and timely manner.

There are many reasons why a wound may not heal and become chronic, including underlying conditions and comorbidities, medications that impede healing, malnutrition, and infection. A non-healing abdominal wound may be affected by the poor vascularity of adipose tissue, possible fistulas or abscesses. These factors should all be assessed. The moist wound healing method should be used, and advanced dressings — such as negative pressure wound therapy, specialty absorptives, collagen, or antimicrobials — may be beneficial depending on the wound bed and exudate characteristics.

If the treating provider does change the ICD-10 code from acute to chronic, the medical decision-making rationale must be clearly documented in the progress note. The progress note "tells the wound story" and needs to be clear to others in the continuum of care, auditors and payors.

Resources in WoundReference that address chronic wounds, determining healability, nutrition for healing, wound dressings, and ICD-10 codes are linked here:

Topic: How to Determine Healability of a Wound

Topic: Principles of Healing
Topic: Wound Care ICD-10 Codes 2025

Topic: How to Screen, Assess, and Manage Nutrition in Patients with Wounds

Topic: Dressing Essentials

Hope this is helpful.

Kim Simonson

Apr 22, 2025

Dominic Santiago
LVN

Thank you for your prompt and informative response.

To clarify further, in the case of surgical wounds that fail to heal within the typical 4–12 week period, would the ICD-10 coding shift from an "A" code (acute) to a chronic wound code apply universally to all acute wounds that become non-healing?

Additionally, when considering advanced modalities such as skin substitute applications, is it appropriate to proceed while the wound is still coded as an "A" code? Based on the LCD guidance stating that covered indications include “the presence of a chronic, non-infected wound that has failed to achieve at least 50% ulcer area reduction after a minimum of 4 weeks of documented standard of care with compliance,” it seems the expectation is for the wound to be classified as chronic.

Would it be accurate to interpret this as a necessary reclassification from acute to chronic before initiating advanced treatments like skin substitutes?

Apr 22, 2025

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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