For ICD-10 purpos es, if there is an ulcer on the foot of Thorough documentation and accurate coding are key. 509 - Non-pressure chronic ulcer of other part of unspecified foot with unspecified severity answers are found in the ICD-10-CM powered by Unbound Medicine. com Common sites of neuroischemic ulcers: Toes, margins of the foot and the dorsum of the foot. Diabetic foot ulcer (DFU) occurs commonly in persons with diabetes, with a lifetime prevalence estimated between 12% and 25%. The underlying premise being DFU is a type of neuroischemic ulcer. 62. Foot ulcers are a common complication in people with diabetes because they are more likely to develop in persons with the disease . E11. stasis ulcer with edema of left foot; Venous stasis ulcer with edema of left foot limited to skin layer; Venous stasis ulcer with edema of left foot with bone necrosis; Venous. Chronic venous hypertension (idiopathic) with ulcer. If the foot ulcer doesnt heal within a month or the infection spreads to the bone, in this case, patients may need other treatments. Surgical treatment of the neuroischemic foot J Cardiovasc Surg (Torino). 529. ICD-10-CM Alphabetical Index References for 'L97. It is estimated that a person with diabetes’ lifetime risk of developing a foot ulcer is 25%, with an uninfected ulcer costing EUR 10,000 and an untreated ischemic ulcer costing EUR 17,000 in 2008 . 8 per 1,000 person-years (95% CI7. 41: Non-pressure chronic ulcer of right heel and midfoot L98. }, author={Jan Apelqvist and. Complete information about the state of foot tissues in chronic neuroischemic ulcers against the background of diabetic foot syndrome allows choosing an adequate treatment strategy using minimally invasive and surgical interventions on the foot. FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. 326 - other international versions of ICD-10 L97. 622 Pain in left upper arm M79. 413 Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle L97. Not only are neuropathic ulcers a burden to the patient but also to the economy. 1 Non-pressure chronic ulcer of thigh. 0% to 4. Ischemic ulcers are typically handled by a vascular service, whether the patient has diabetes or not. 499 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Consecutively presenting patients with diabetes and ischemic/neuroischemic foot ulcer (Wagner grade 1–5, at or below the ankle) admitted to a multidisciplinary foot centre between 1984 and 2006 (n = 1151; Fig. While all wounds are colonized with microorganisms, the presence of infection is defined by ≥2 classic findings of inflammation or purulence. 621 Type 2 diabetes mellitus with foot ulcer. 17. Coding, Compliance, and Documentation for Diabetic Foot Ulcers By Jeffrey D. Conclusions: Wounds of different etiology show unique dermal microcirculatory changes prior to gross ulceration. 621, E10. The ICD-10-CM code E11. ICD-10 Codes for Diabetic Foot Ulcers. 62 [1. Centers for Medicare and Medicaid Services and the National Center for Health Statistics; 2018. Foot ulceration in diabetes can either be associated with neuropathy (neuropathic ulcer), peripheral vascular disease (ischemic ulcer), or both (neuroischemic ulcer), although the final etiopathogenetic pathway may involve a combination of these primary risk factors and other causal factors such as trauma. Prevalence of DFUs among diabetic patients is reported to be between 4% and 10%, with an estimated lifetime incidence of almost 25% (Singh, Armstrong, & Lipsky, 2005). Diabetic foot ulcer (DFU) management with a concise algorithm which can be used at the point-of-care. The highly complex and integrated process of wound healing is regulated by a large array of. of right foot with inflammation; Venous stasis edema with ulcer of right toe; Venous stasis edema. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code Z87. Short description: Athscl native art of right leg w ulcer of heel and midfoot The 2024 edition of ICD-10-CM I70. Neuroischemic ulcers can also develop on the tips of toes and beneath overly thick toenails. The IDSA 2012 guidelines stated that the U. ICD-10-CM Codes › L00-L99 › L80-L99 › Non-pressure chronic ulcer of lower limb, not elsewhere classified L97 Non-pressure chronic ulcer of lower limb, not elsewhere classified L97-Emerging Evidence for Neuroischemic Diabetic Foot Ulcers: Model of Care and How to Adapt Practice July 2009 The International Journal of Lower Extremity Wounds 8(2):82-94Introduction. ogy of diabetic foot ulcer (DFU) is neuropathy and loss of protective sensation [9]. Ulcer was considered deep to the bone in the case of bone exposure or positive probe-to-bone test. Diabetic foot ulcers (DFUs) are one of the most serious and disabling complications of diabetes. The outcome in this study was plantar foot ulcer recurrence in 18 months. E11. 1 Many parameters have been identified as possible predictors for poor outcome in patients with diabetic foot disease, for example, renal failure, dialysis, infection, gangrene and PAD. Patients with recurrent foot ulcers had higher vibration perception threshold values. Diabetic foot ulcers are potentially modifying complications. Short description: Non-prs chronic ulcer of left heel and midfoot w unsp severt The 2024 edition of ICD-10-CM L97. I70. CODING . CORNER. Risk factors. People who have diabetes and a prior foot ulcer are reported to have a crude fourfold increased mortality at a median of 3. ICD List 2023-2024 Edition. 621 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. L97. 245: 440. Approximately 15% of individuals with a neuropathic ulcer require limb amputation as a result of infection. ICD-10-CM Diagnosis Code L97. It is now appreciated that 15 – 20% of patients with such foot ulcers go on to need an amputation. Diabetic foot ulcer management: the podiatrist's perspective. 13 While rarely the primary cause of foot ulcers, the presence of limb ischemia increases the risk of an ulcer becoming infected 4,. Materials and Methods: Between April 2009 and July 2017, 167 diabetic patients (mean age 72. 429 for Non-pressure chronic ulcer of back with unspecified severity is a medical classification as listed by WHO under the range - Diseases of the skin and subcutaneous tissue . Currently, a specific limb salvage protocol including lower-limb revascularization for managing ischemic diabetic foot ulcers (DFUs) is well established . S. This is the American ICD-10-CM version of E10. Our findings of a crude 2. In this regard, against theGet free rules, notes, crosswalks, synonyms, history for ICD-10 code I70. Icd 10 Code Diabetic Foot Ulcer Left Toe. I70. All other Codes (ICD-10, Bill Type, and Revenue) have. 606 Pain in leg, unspecified M79. Emerging Evidence for Neuroischemic Diabetic Foot Ulcers: Model of Care and How to Adapt Practice. 326 may differ. 8 707. Applicable To. 15. Diabetic foot ulcers affect approximately 18. Non-pressure chronic ulcer of other part of foot : L97. 25 is grouped within Diagnostic Related. ICD 10 code for Non-pressure chronic ulcer of other part of right foot with necrosis of bone. Emerging Evidence for Neuroischemic Diabetic Foot Ulcers: Model of Care and How to Adapt Practice. I70. Differential diagnosis of leg ulcers. Athscl native arteries of right leg w ulcer of unsp site; The 2024 edition of ICD-10-CM I70. 5 Neuroischemic/ischemic ulcers were considered present at ankle pressure <80 mm Hg or toe pressure <45 mm Hg or at Wagner grades 4 to 5 if distal pressure was not obtained. Type 2 diabetes mellitus with foot ulcer; ICD -10- CM E11. Local paresthesias, or lack of sensation, over pressure points on the foot leads to extended microtrauma, breakdown of overlying tissue, and eventual ulceration. 621) Z86. g. Neuropathic ulcers were defined as ulcers of patients with vibration threshold >25 V and a palpable foot pulse, neuroischemic ulcers as. 7); a history of recurrent foot ulcers (OR, 2. What You Should Know About ICD-10 Diabetic Foot Ulcer Codes. Click on any term below to browse the alphabetical index. In many instances, foot ulcers and amputation can be. Stop Using “Unspecified” ICD-10 Codes. As the prevalence of diabetes increases all over the world, the number of patients with a DFU is also growing [2], making it a global public. epidemiology, risk factors, etiology, pathophysiology, history, physical examination, diagnosis, differential diagnoses, documentation and ICD-10 coding) Ndip A, Jude EB. 2. This is the American ICD-10-CM version of M62. 8 707. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code I70. Diabetic foot. 409 became effective on October 1,. The combination of most expensive ulcer and most expensive surgery yielded a cohort of 2355 patients with the highest average cost of $177,400 per patient ($78,800 annualized). for each additional 100 sq cm* of wound surface area. This is the American ICD-10-CM version of L97. Nov 28, 2019. 909 is grouped within Diagnostic Related Group(s) (MS-DRG v 41. 101 Non-pressure chronic ulcer of unspecified thi. Use Additional. 621 may differ. ICD-9-CM 707. Diabetic foot problems were confirmed by one of the following physician’s handwritten diagnosis as: ‘diabetic foot’, ‘diabetic foot ulcers’, ‘diabetic footNeuroischemic ulcers – occur where the person has both peripheral neuropathy and ischemia resulting from peripheral artery disease. Ischemic ulcers are often located distally and on the dorsum of the foot or toes. The risk is high (8 points). 14 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 707. E11. L97 Non-pressure chronic ulcer of lower limb, not. Ulcer ulcerated ulcerating ulceration ulcerative 707. jvs. Results. 621 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Neuropathic ulcers occur when a patient with the poor neurological function of the peripheral nervous system has pressure points that cause ulceration through the epidermal and dermal tissue layers. 0):Ulcer diagnosis was categorized into neuropathic, ischemic and neuro-ischemic according to the result of biothesiometry, palpable pedal pulses and distal blood pressure measurement of the foot. In addition, neuropathy can allow minor scrapes or cuts. Conclusions: The resource burden for management of neuroischemic ulcers of the lower extremity in patients with peripheral artery disease is substantial. 2. As many as 1% of older people in the Western world are at risk of developing a foot ulcer as a complication of diabetes mellitus. The study group was composed of DFUs patients managed by a limb salvage protocol according to guidance. 13 Recently the International Working Group on the Diabetic Foot (IWGDF) has updated its guidelines on the diagnosis and treatment of foot infection in persons with diabetes. L97. Neuropathic foot ulcers form as a result of a loss of peripheral sensation and are typically seen in individuals with diabetes. Among other required ICD10-CM codes, the L97- ICD10-CM code options for a left plantar heel di-abetic foot ulcer whose deepest depth of tissue exposed is subcutaneous tissue include: Don’t open yourself up to an unnecessary audit. Columbia, MO. 622 may differ. Peripheral arterial disease, intermittent claudication and peripheral vascular disease are all codes to:. In general, a non-occlusive and moist wound therapy is recommended to treat diabetic foot ulcers [8,42,43,44]. by Dr. 5-fold increased risk at 10 years’ follow-up compared with patients with diabetes and no history of foot ulcer. E11. Diabetic foot problems were confirmed by one of the following physician’s handwritten diagnosis as: ‘diabetic foot’, ‘diabetic foot ulcers’, ‘diabetic foot infections’, or ‘diabetic foot gangrene’. 672 may differ. Photographs of the plantar foot, taken at each study visit or in between. Foot Study. U. 1. 1 entered into multivariable logistic regression models to examine factors independently associated with each outcome. @article{Apelqvist2011FactorsRT, title={Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients. Of all patients, 15% had lower-limb amputations as a result of their nonhealing ulcers, 65% had ulcers that. The 2024 edition of ICD-10-CM E10. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM. than the diabetes mellitus, and ICD-10-CM instructs to code first any associated gangrene. Code Classification: Endocrine, nutritional and metabolic diseases (E00–E89) Diabetes mellitus (E08-E13) Type 2 diabetes mellitus (E11) E11. Drug or chemical induced diabetes mellitus with foot ulcer. Short description: Athscl native arteries of left leg w ulceration. This makes neuropathic ulcers an important therapeutic target. The key factor in healing an arterial ulcer is: Choice of dressing Compression Debridement Revascularization. Poor diabetic control and high haemoglobin A1c. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code L97. Bandyk DF Semin Vasc Surg 2018 Jun-Dec;31(2-4):43-48. Recurrent foot ulcer: New ulcer in a patient who has a history of ulceration, irrespective of location and time, since previous foot ulcer. Short description: Ulcer other part of foot. Annual incidence of foot ulcers is 1% to 4% and prevalence 5% to 10% in patients with diabetes (). 004) as well as with minor or major amputation among patients with neuropathic ulcers (2. 621 is VALID for claim submission. 239 became effective on October 1,. 2009;82-94. 25 - other international versions of ICD-10 I70. The pathophysiology of diabetic foot ulcers includes progressive development of a sensory, motor, and autonomic neuropathy. Showing 1-25: ICD-10-CM Diagnosis Code L97. Our findings of a crude 2. ICD 10 code for Non-pressure chronic ulcer of other part of unspecified foot with fat layer exposed. Diagnostic Considerations. 505. Before predictive models can be. Foot temperature is warm and foot pulses palpable. Short description: Non-pressure chronic ulcer of skin of sites. ICD 10 code for Atherosclerosis of native arteries of right leg with ulceration of unspecified site. 1. Foot ulceration in diabetes can either be associated with neuropathy (neuropathic ulcer), peripheral vascular disease (ischemic ulcer), or both (neuroischemic ulcer), although the final etiopathogenetic pathway may involve a combination of these primary risk factors and other causal factors such as trauma. 245 [convert to ICD-9-CM] Atherosclerosis of native arteries of left leg with ulceration of other part of foot. 6 years’ follow-up , a 2. 622 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. In the Alphabetic Index of Diseases, there is Ulcer>Skin which has the assortment of Synonyms (which I would interpret as "includes"): Atrophic, Chronic, Neurogenic, Non-healing, Perforating,. A total of 59 patients with diabetic foot ulcer were co-managed by the Department of Orthopedics during this period of the pandemic. The main clinical outcomes for the 194 diabetic foot ulcers are shown in Table 3. I70. A duration of diabetes of at least 10 years. 33 vs. Conclusions: Based on the etiological ulcer type, DFU healing course and several patient factors differed. Foot ulcers and their complications are an important cause of morbidity and mortality in patients with diabetes. Print Post. Neuroischemic Diabetic Foot Ulcers / Ndip and Jude 83 management if prevention fails cannot be overem-phasized. Icd 10 Stage 3 Pressure Ulcer Sacrum. Neuroischemic foot ulcer; Neuropathic ulcer of foot due to diabetes mellitus; Neuropathic ulcer of foot due to diabetes mellitus;. Toggle navigation. 52. I70. 67 y/o), had more co-morbidities, and presented with. 15. ICD 10 code for Personal history of diseases of the skin and subcutaneous tissue. Code Version: 2022 ICD-10-CM. Complexity of factors related to outcome of neuropathic and neuroischemic/ischemic diabetic foot. Diabetic foot is one of the most significant and devastating complications of diabetes, and is defined as a foot affected by ulceration that is associated with neuropathy and/or peripheral arterial disease of the lower limb in a patient with diabetes. 011 [convert to ICD-9-CM] Ischemic optic neuropathy, right eye. Neuropathic foot ulcers form as a result of a loss of peripheral sensation and are typically seen in individuals with diabetes. In Western countries, the annual incidence of foot ulceration in the diabetic population is around 2%. The 2022 edition of ICD-10-CM E11. Peripheral Arterial D isease . 621 (Type 2 diabetes mellitus with foot ulcer) first. Routine perfusion assessment detects some degree of PAD in at least 50–60% of DFU patients [10,11]. These types of wounds can be slow to heal. 629 Pain in unspecified upper arm M79. ance in this area. The leading cause of amputation in patients with diabetes is the nonhealing foot wound and its complications. L97. This system assesses ulcer depth and the presence of osteomyelitis or gangrene. Despite best practice, 30–40% of DFUs do not heal within 12–20 weeks (). They are often seen on the margins of the foot and also develop on the tips of the toes and beneath any toe nails if these become overly thick. L97 ICD-10-CM Diagnosis Code L97 Non-pressure. Diabetic foot ulcers can be divided into two groups: those in neuropathic feet (so called neuropathic ulcers) and those in feet with ischaemia often associated with. 621 Pain in right upper arm M79. The purpose of this study was to identify factors related to healing in patients with diabetes with foot ulcers and severe PVD. Non-pressure chronic ulcer of plantar surface of midfoot. The 2024 edition of ICD-10-CM M14. Learn about diabetic foot ulcers, a common and costly complication of diabetes that often leads to lower limb amputation, and the role peripheral arterial disease (PAD) plays in its development and severity. to dm 2; Neuropathic ulcer of left foot; Neuropathic ulcer of left toe; Postthrombotic ulcer of left foot; Postthrombotic ulcer of left foot with inflammation. 9 became effective on October 1, 2023. , presence of foot ulcers greater. The purpose of this study was to identify factorsthe first 100 sq cm of the foot/digit wound(s) treated. Risk factors for developing a diabetic foot ulcer include: Type 2 diabetes being more common than type 1. Diabetes Mellitus * E10: Insulin. Conclusions: The resource burden for management of neuroischemic ulcers of the lower extremity in patients with peripheral artery disease is substantial. , pressure mitigation, often by means of padding, shoe modifications, contact casts, boots, or non-weight-bearing strategies). Dm 2 with neuropathic ulcer foot and heel; Neurogenic erectile dysfunction due to type 2 diabetes mellitus; Neuropathic midfoot and/or heel ulcer due to type 2 diabetes mellitus;. 239 became effective on October 1, 2023. Diabetic Neuro-Osteoarthropathy—A Special Feature of Diabetic Foot Syndrome. 2 (11. 6 billion. #2. In recent years, several studies appeared to demonstrate improved rates of limb salvage associated with revascularization in comparison to the medical treatment in patients with peripheral. Best answers. E11. Short description: Local infection of the skin and subcutaneous tissue, unsp The 2024 edition of ICD-10-CM L08. Diabetic foot ulcers are a major healthcare problem. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers. DFUs healed within 3 and 12 months were the primary outcomes, as different factors have been reported to influence short- and longer-term healing (2–4). 6. 329 became effective on October 1, 2023. The presence of peripheral vascular disease (PVD) is a strong predictor of non-healing foot ulcers 9, with diabetic. M14. 621, E13. In one instance, factors that were significantly associated (by multivariate analysis) with developing a foot infection included having a wound that extended to bone (based on a positive PTB test; odds ratio [OR], 6. ICD 10 code for Non-pressure chronic ulcer of other part of left foot with bone involvement without evidence of necrosis. The treatment for both pressure ulcers and diabetic foot ulcers includes offloading (i. 621. Ischemic ulcers (wounds) can occur when there is poor blood flow in your legs. 2: Someone was asleep when you. 621 became effective on October 1, 2023. 5% of the adult population, and the increase in prevalence is occurring at a faster rate in low- and middle-income countries. 1,4,7,8 Noninvasive vascular testing has been shown to predict probability for healing of diabetic foot ulcers. The presence of diabetes increases the risk of an amputation of a leg, foot, or toe by approximately 23 times that of a person without diabetes. This is the American ICD-10-CM version of I70. It is now appreciated that 15 – 20% of patients with such foot ulcers go on to need an amputation. Evidence-based review on arterial ulcer. Neuro-ischemic Ulcer with Osteomyelitis under the Hallux. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code L97. 5-fold increased risk at 10 years’ follow-up compared with patients with diabetes and no history of foot ulcer. Most amputations in people with diabetes are preceded by ulceration of the foot, and it is estimated that around 7000 people with diabetes are affected by ulceration of the foot at any one time in. 15 should only be used for claims with a date of service on or before September 30, 2015. In addition, in the work of Gershater et al. ICD 10 code for Atherosclerosis of native arteries of right leg with ulceration of other part of foot. 23); ulcers were considered ischemic when ICD code 440 or 250. . The 2024 edition of ICD-10-CM I96 became effective on October 1, 2023. 15 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 707. ICD-9-CM 707. Five-year mortality was 18%, 45% and 55% for neuropathic, neuroischemic and ischemic ulcers, respectively. 02. ICD-10-CM Diagnosis Code L97. What ICD-10 Codes are Used for Foot Ulcers? Check below for a list of ICD Codes for foot ulcers that healthcare professionals can use for medical coding, diagnosis documentation, communication, and billing. It is one of the major causes of amputations, particularly in patients with uncontrolled diabetes. 493 ICD-10 code L98. with a neuroischemic foot (86%. or neuroischemic, depending on how complications such as peripheral neuropathy and arterial disease affect the ulcer’s etiology. 33–4. 622 became effective on October 1, 2023. Summary. n engl j med 351;1 july 1, 2004 clinical practice 49 of assessment of foot pulses, noninvasive assess-ment of the peripheral circulation is recommended Diabetic foot ulcer has an annual incidence of 2–6% and affects up to 34% of diabetic patients during their lifetime. . Debridement is mentioned in the context of general treatments for neuroischemic ulcers. Synonyms: chronic neurogenic ulcer of lower limb, chronic ulcer of ICD List 2023-2024. 621 might also be used to specify conditions or terms like chronic neurogenic ulcer of lower limb, chronic ulcer of foot, chronic ulcer of foot, chronic ulcer of foot, chronic ulcer of left foot due to diabetes mellitus , chronic ulcer of right foot due to diabetes mellitus, etc. Short description: Athscl native art of left leg w ulcer of heel and midfoot The 2024 edition of ICD-10-CM I70. 6 million in the United States each year. The diabetic foot: Pathophysiology, evaluation, and treatment. 622 may differ. The higher cost share (85%) was for the management of patients with neuroischemic foot without ulcer (Int $ 285. . 14, 16, 17, 20, 22, 26 – 29 It is also generally accepted that people with diabetes should be offered specific education about preventive foot care. 3 DFUs in the context of combined neuroischemic disease exhibit worse outcomes. The 2022 edition of ICD-10-CM L97. g. The presence or absence of infection and/or ischemia, footwear and pressure relief, and. 1. 0, diabetic foot ulcers are captured in Section M1 (Ulcers Due to Any Cause) and Section I3 (Other Current Diagnoses and ICD-10-CA Codes). Non-pressure chronic ulcer of other part of foot; ICD-10-CM L97. Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. What ICD-10 Codes are Used for Foot Ulcers? Check below for a list of ICD Codes for foot ulcers that healthcare professionals can use for medical coding, diagnosis documentation, communication, and billing. On the other hand, ischaemic ulcersDiagnosis Code: L97. Poor diabetic control and high haemoglobin A1c. I96 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. ICD-10-CM Diagnosis Code L89. Diabetic Neuropathic Foot Ulcers. 1–€1. 621 - other international versions of ICD-10 E11. g. Diabetic foot ulcers can be divided into two groups: those in neuropathic feet (so called neuropathic ulcers) and those in feet with ischaemia often associated with neuropathy (so called. Family physicians should consider patient risk factors (e. Patient with diabetes with lower extremity ulcer of neuropathic, neuroischemic or ischemic etiology. Regarding the positive clinical outcomes of sucrose octasulfate impregnated dressing documented in neuroischemic diabetic foot ulcers (DFUs), we aimed to evaluate the microcirculatory status in patients with neuroischemic DFU through the use of sucrose octasulfate dressing. Diabetic neuropathy results in foot deformity, leading to increased skin pressure with walking. 40: Non-pressure chronic ulcer of unspecified heel and midfoot; L97. The 2024 edition of ICD-10-CM L89. 5-) ICD-10-CM Diagnosis Code E13. 245. de. 2001;24:. Musculoskeletal Exam . These patients have a high. L97. Treatment strategies for neuroischaemic diabetic foot ulcers. 500 results found. L97. •Trophic skin changes (e. 2002;66 (9):1655-1663. 272. 672 became effective on October 1, 2023. #2. 519 [convert to ICD-9-CM] Non-pressure chronic ulcer of other part of right foot with unspecified severity. 245: 707. Ischemic ulcers are often located distally and on the dorsum of the foot or toes. Here is the textbook definition of the Wagner Ulcer Grade Classification system: Wagner Ulcer Grade classification System Catergorizes dysvascular ulcers based on WOUND DEPTH and the presence of INFECTION.