There Is No ICD-10-CM Code for Skin Failure, and PAWSIC’s Position Paper Makes the Case for One

PAWSIC calls on clinicians, medical coders, and healthcare organizations to recognize skin failure, distinct from pressure injury, in ICD-10-CM.

QUAKERTOWN, Pa., Sept. 30, 2026: There is no dedicated ICD-10-CM diagnostic code for skin failure, and the Post Acute Wound & Skin Integrity Council (PAWSIC) has published a position paper making the case for one. The PAWSIC Skin Failure Codes Position Paper: The Case for ICD-10-CM Diagnostic Codes for Skin Failure (PSFCPP), Version 1.1, sets out the clinical rationale and evidence for a dedicated skin failure code and invites clinicians, medical coders, professional bodies, and healthcare organizations to read the paper and consider endorsing it.

Skin failure is skin breakdown that occurs in patients with severe illness, physiologic decline, or advanced frailty, or who are nearing the end of life, including acute skin failure associated with hypoperfusion and critical illness. Clinicians document it in practice, and the scientific literature describes it. Without a dedicated ICD-10-CM code, skin failure is often recorded as a different wound type, most commonly a pressure injury, even though the two are clinically distinct. That gap affects patient-centered care, documentation, communication, quality measurement, and research.

“The Post Acute Wound and Skin Integrity Council (PAWSIC) recognizes skin failure as an increasingly identified clinical phenomenon associated with systemic physiologic compromise. PAWSIC supports the development of an ICD-10-CM skin failure code framework that reflects contemporary clinical practice while allowing for continued scientific refinement as evidence evolves.” PAWSIC Position Statement

The paper is framed as a call to begin the coding conversation, with a framework designed to be refined as evidence develops, rather than a claim that the science is settled.

The timing reflects a documentation gap. October 2023 guidance from the Centers for Medicare & Medicaid Services (CMS) states that Skin Changes at Life’s End (SCALE), Kennedy Terminal Ulcers, and skin failure are not primarily caused by pressure and should not be documented as pressure injuries on the Minimum Data Set. No dedicated diagnostic code currently exists to record that distinction.

The primary authors are Diane Krasner, PhD, RN, FAAN, FAAWC, MAPWCA, WOCNF; Jeanine Maguire, PhD, MPT, CWS, FCPP; and Ronald Rosen, MD, CMD, CWSP. Thomas P. Stewart, PhD, served as Senior Advisor. The paper received review from PAWSIC Skin Failure Shared Interest Group members and final approval from the PAWSIC Board of Directors.

“I am incredibly proud of this PAWSIC Skin Failure Codes Position Paper. It represents years of collaborative dedication from our interdisciplinary clinical team, capturing the rich history of this condition, addressing current gaps, and grounding our approach firmly in patient-centered care. Thank you to everyone whose tireless effort made this milestone possible.” Jeanine Maguire, PhD, MPT, CWS, FCPP, President of PAWSIC

The position paper presents PAWSIC’s recommendations for the development of diagnostic codes. It does not establish new codes or replace professional clinical or coding guidance. Its intended audience includes wound care clinicians, post-acute care leaders, researchers, and professional organizations involved in skin integrity and patient care.

Individuals and authorized organizational representatives are invited to endorse the paper after reading it in full. Endorsement signifies support for the positions and recommendations in Version 1.1. It does not indicate participation in the paper’s development or membership in PAWSIC.

Endorse the Position Paper →