ICD 10 code for Non-pressure chronic ulcer of other part of unspecified foot with necrosis of bone. 7% had no identified underlying factors. 622 became effective on October 1, 2023. 509 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. In 2011, 350 million people worldwide (6. 621 is a billable diagnosis code used to specify type 2 diabetes mellitus with foot ulcer. 4-, L97. Diabetic neuro-osteoarthropathy (DNOAP) or Charcot’s foot is characterised by a sterile destruction of bones and joints. 2015. The 2022 edition of ICD-10-CM L97. L97. Short description: Ulcer other part of foot. 0% to 4. E11. 529 [convert to ICD-9-CM] Non-pressure chronic ulcer of other part of left foot with unspecified severity. Short description: Athscl native art of left leg w ulcer of heel and midfoot The 2024 edition of ICD-10-CM I70. Debridement is mentioned in the context of general treatments for neuroischemic ulcers. There is an open, draining ulceration noted on this distal tip, third toe, left foot. foot with muscle necrosis due to diabetes mellitus type 1; Diabetic ulcer of right foot with muscle. Centers for Medicare and Medicaid Services and the National Center for Health Statistics; 2018. Heel ulcers, however, are usually a. › icd 10 code for left foot ulcer. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code L97. The code E11. One or more of these fac- tors can be identified in more than 90% of chronic lower extremity ulcers. 4 - other international versions of ICD-10 L97. Family physicians should consider patient risk factors (e. Code Version: 2022 ICD-10-CM. 1 Complications of foot ulcers are the leading cause of hospitalisation and amputation in. This system assesses ulcer depth and the presence of osteomyelitis or gangrene. I70. 1. 102 Non-pressure chronic ulcer of unspecified thi. 13 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 707. Diabetic ulcers typically involve the foot starting on the toes and moving upward. Ischemic means reduced blood flow to an area of the body. The primary reason for the admission was for treatment of the gangrenous pressure ulcer. Arterial ulcer: note the characteristic hypoxic, scarce bleeding, and atone tissue aspect after local debridement (A). 621 became effective on October 1, 2023. 3 kPa (32 mmHg) White blood cell count > 12 000/mm3 or < 4000/mm3,or > 10% immature (band) forms. The high prevalence and incidence of diabetes and its attendant foot complications, coupled with the curren. A diabetic foot ulcer, which is caused exclusively by hyperglycemia, in the absence of neuropathy or ischemia, is a rarity. For details, refer to section 'Wagner Classification' in topic " Diabetic Foot Ulcer - Hyperbaric Oxygen Therapy". 245: 707. 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 . e. Diabetic foot ulcers (DFU) are associated with significant impairment of quality of life, increased morbidity and mortality, and are a huge drain on health care resources. 516. Peripheral arterial disease, intermittent claudication and peripheral vascular disease are all codes to:. 524 - Non-pressure Chronic Ulcer of Other Part of Left Foot With Necrosis of Bone [Internet]. 509. 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. ICD 10 code for Atherosclerosis of native arteries of right leg with ulceration of other part of foot. 621 became effective on October 1, 2021. Foot ulcers are a significant complication of diabetes mellitus and often precede lower-extremity amputation. 5- Non-pressure chronic ulcer of other part of lower leg : L97. In Western countries, the annual incidence of foot ulceration in the diabetic population is around 2%. 523. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers. The classic diabetic trophic ulcer must be distinguished from various other problems that tend to occur in persons with diabetes, such as diabetic dermopathy, bullosis diabeticorum, eruptive xanthoma, necrobiosis lipoidica, and granuloma annulare. Recurrent foot ulcer: New ulcer in a patient who has a history of ulceration, irrespective of location and time, since previous foot ulcer. Matilde Monteiro-Soares are co-authors of the chapter, “Peripheral Arterial Disease, Foot Ulcers, Lower. In the RAI-MDS 2. This is the American ICD-10-CM version of E11. The ICD-10-CM code E11. 516 is grouped within Diagnostic Related Group(s) (MS-DRG v 41. 4, 440. Approximately 15% of individuals with a neuropathic ulcer require limb amputation as a result of infection. 6. foot 250. 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)ICD 10 code for Non-pressure chronic ulcer of other part of right foot limited to breakdown of skin. [email protected] demographic, comorbidity, limb, ulcer, and treatment-related factors associated with healing of DFUs have been identified from cohorts attending mostly metropolitan tertiary centers (2–4). 429 became effective on October 1, 2023. DOI: 10. CODING . Pressure ulcers form in sites that experience shear or pressure, typically in tissue overlying bony prominences such as elbows, the sacrum, hips, or heels. 413 is a valid billable ICD-10 diagnosis code for Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle . 90 became effective on October 1, 2023. 621 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 90 may differ. 40: Non-pressure chronic ulcer of unspecified heel and midfoot; L97. 621. 672 became effective on October 1, 2023. Foot ulcers will occur in 5-10% of the diabetic population; up to 3% will have a lower-limb amputation(). 509 [convert to ICD-9-CM] Non-pressure chronic ulcer of other part of unspecified foot with unspecified severityIn diabetic foot clinics, there has been a paradigm shift away from a focus on ulcers in neuropathic feet and toward ulcers in neuroischemic feet, which occur more frequently. Continued on page 72 THE DIABETIC fOOT Claudication was defined as recurrent cramping pain or tightness in the calf induced by exercise and relieved by rest. 2. Foot ulcers were identified through the regional hospital discharge system, which contains ICD codes of current diagnoses (ICD codes 707 or 440. This makes neuropathic ulcers an important therapeutic target. ↓ See below for any exclusions, inclusions or special. Introduction. ; Diabetic ulcer of right toe with muscle necrosis due to dm 2; Neuropathic ulcer of right foot with muscle. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code L97. 892 may differ. 526 is grouped within Diagnostic Related Group(s) (MS-DRG v 41. Aims/hypothesis We sought to identify factors related to short-term outcome of foot ulcers in patients with diabetes treated in a multidisciplinary system until healing was achieved. Search Results. However, the presence of. In diabetic foot clinics, there has been a paradigm shift away from a focus on ulcers in neuropathic feet and toward ulcers in neuroischemic feet, which occur more frequently. -) ICD-10-CM Diagnosis Code I87. Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. 15. 245 [convert to ICD-9-CM] Atherosclerosis of native arteries of left leg with ulceration of other part of foot. Purpose: To assess the clinical efficacy of endovascular angiosome-oriented wound-targeted revascularization (WTR) vs indirect (wound-indifferent) revascularization (IR) in diabetic patients with neuroischemic foot ulcers. 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. of other part of foot . The 2022 edition of ICD-10-CM E11. 504. ICD-10-CM Coding Rules I70. 6 years’ follow-up , a 2. Almost 85% of the amputations are preceded by diabetic foot ulcers. 1,7,9 Few studies evaluate outcome in ischemic or neuroischemic foot ulcers irrespective of vascular interven-tion. 8-Non-pressure chronic ulcer of unspecified part of lower leg :A pilot study to evaluate the efficacy of class IV lasers on nonhealing neuroischemic diabetic foot ulcers in patients with type 2 diabetes Diabetes Care . Get free rules, notes, crosswalks, synonyms, history for ICD-10 code I70. 41: Non-pressure chronic ulcer of right heel and midfootL98. 672 may differ. Short description: Non-prs chronic ulcer of left heel and. ICD 10 code for Nontraumatic ischemic infarction of muscle, left ankle and foot. Abstract. Foot infections are a common and serious problem in persons with diabetes. , presence of foot ulcers greater. The key factor in healing an arterial ulcer is: Choice of dressing Compression Debridement Revascularization. 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. ICD-10-CM Diagnosis Code L97. code to specify site and severity of ulcer (L97. Pressure injuries with skin breakdown are considered pressure ulcers. This is the American ICD-10-CM version of E11. The annual incidence of diabetic foot ulcer worldwide is between 9. The purpose of this study was to identify factorsthe first 100 sq cm of the foot/digit wound(s) treated. The annual population-based incidence of DFUs ranges from 1. Deep foot ulcer†: An ulcer penetrating below the dermis into subcutaneous structures, such as fascia, muscle. The cost of diabetic foot ulcer care is approximately $1. U. 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. In the modern era, it is evident that the majority of foot ulcers also have an ische-mic element. 234 became effective on October 1, 2023. In many instances, foot ulcers and amputation can be. 31 In 2a, there were focal increases in StO 2 and decreases in HbT 1 at the initial pre-ulcerative sites on the distal hallux, briefly displaying signatures more consistent with neuropathic. L97. Conclusions: Based on the etiological ulcer type, DFU healing course and several patient factors differed. Foot ulcer due to type 2 diabetes mellitus. When a minor trauma occurs and local edema occludes a superficial branch of a small artery of the skin below it in the presence of neuropathy, a shallow neuro-ischemic ulcer may form over the ischemic area. 2 The risk of developing a DFU, and the factors. Applicable To. 605 Pain in left leg M79. These ulcers occur more often in the digits (toes) and the lateral (side) aspects of the foot. Look-Ups. with necrosis of bone. 03). 519. 006 Corpus ID: 20860603; Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients. 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). 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. . Diabetic foot ulcers affect approximately 18. Non-pressure chronic ulcer of other part of unspecified foot with necrosis of bone. Short description: Non-prs chronic ulcer of unsp heel and midfoot w unsp severt The 2024 edition of ICD-10-CM L97. For prevention and. 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. In the case of neuroischemic foot ulcer, antibiotics should be chosen carefully as it is more serious than an neuropathic foot ulcer 9. 2015 Oct;38(10):e152-3. The resultant debility and disability constitutes a burden for both individuals and their health. and a foot ulcer range from 10% to 60%. In a sub-analysis of those. Neuroischemic ulcers. Showing 1-25: ICD-10-CM Diagnosis Code L97. Surgical treatment of the neuroischemic foot J Cardiovasc Surg (Torino). Get free rules, notes, crosswalks, synonyms, history for ICD-10 code I70. Diabetic foot ulcer management: the podiatrist's perspective. Perhaps the most unpleasant potential consequence of DFU besides death is lower extremity amputation (LEA). A duration of diabetes of at least 10 years. The outcome in this study was plantar foot ulcer recurrence in 18 months. Diabetic foot ulceration is a devastating complication of diabetes that is associated with infection, amputation, and death, and is affecting increasing numbers of patients with diabetes mellitus. Ischemic ulcers (wounds) can occur when there is poor blood flow in your legs. Type 2 Diabetes Mellitus With Foot Ulcer. Short description: Athscl native arteries of right leg w ulcer of unsp site The 2024 edition of ICD-10-CM I70. Diabetic foot infections (DFIs) typically begin in a wound, most often a neuropathic ulceration. B. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code L97. Diagnostic Considerations. severe diabetic foot complication. Both studies, however, had only short. 622 is a billable diagnosis code used to specify type 2 diabetes mellitus with other skin ulcer. 02. 101 Non-pressure chronic ulcer of unspecified thi. Cadaveric cryopreserved skin allografts can be used to stimulate healing, particularly for deep wounds with exposed bones and tendons (Snyder and Simonson, 1999). Neuroischemic ulcers in diabetic foot are easily infected; however, infection is rarely the cause of the ulcers. 14 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 707. jvs. Grade 1 – superficial ulcer of skin or subcutaneous tissue. Am Fam Physician. Evidence has shown that debridement of diabetic foot ulcers enhances the healing process when combined with standard wound care for a diabetic foot ulcer. L97. 4) for any ulcer. 2013 Mar;28 Suppl 1:55-60. 2. Emerging Evidence for Neuroischemic Diabetic Foot Ulcers: Model of Care and How to Adapt Practice. L97. BY JEFFREY LEHRMAN, DPM. The effects of peripheral neuropathy, peripheral vascular disease, and infection often combine to facilitate ulcer development that can lead to gangrene and amputation. The treatment for both pressure ulcers and diabetic foot ulcers includes offloading (i. e. The risk for a patient with diabetes to develop a foot ulcer is close to 25% 1 leading frequently to disablement and leg amputation. 500 results found. Venous ulcers (venous insufficiency ulceration, stasis ulcers, stasis dermatitis, varicose ulcers, or ulcus cruris) are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs (hence leg ulcers). S. Ulcer ulcerated ulcerating ulceration ulcerative 707. 8 Intensive preventive strategies, including patient education, foot care, and the use of appropriate footwear, may. 24, 785. Poor diabetic control and high haemoglobin A1c. 429 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. L97. If the patient has this condition and the diabetic foot ulcers, then code both conditions and you may use the peripheral angiopathy with gangrene first listed. 515. 222 became effective on October 1, 2023. ICD 10 code for Non-pressure chronic ulcer of other part of right foot with bone involvement without evidence of necrosis. 509 - Non-pressure chronic ulcer of other part of unspecified foot with unspecified severity was found in ICD-10-CM 2023, trusted medicine information. The average time in which 50% of patients had healed wounds was 70, 113, and 233 days for neuropathic, neuro-ischemic, and ischemic ulcers, respectively. 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. Few studies evaluate outcome in ischemic or neuroischemic foot ulcers irrespective of vascular intervention. The outcome in this study was plantar foot ulcer recurrence in 18 months. Although neuropathic ulceration remains the commonest type of foot ulcers among patients with diabetes, recent data suggest that ischemic (and therefore, neuroischemic) ulcers are on the rise. 621 - Type 1 diabetes with. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code L97. 0, 440. ICD 10 code for Non-pressure chronic ulcer of left ankle with bone involvement without evidence of necrosis. 622. 10. 622 may differ. 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. Deep tissue injury (DTI) pressure ulcers are defined as ‘purple or maroon localized area of discolored intact skin or blood‐filled blister due to damage of underlying soft tissue from pressure and/or shear’ 1. Diabetic foot ulcers occur in approximately 15% of persons with diabetes. The term 'ulcer' by itself (and not qualified as a 'foot ulcer' or a 'diabetic ulcer') is not linked in the ICD-10 to diabetes, so without documentation to support that it is a complication of the diabetes, we would not presume the causality and would code them separately. Book FREE Doctor Appointment. 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. 312 [convert to ICD-9-CM] Chronic venous hypertension (idiopathic) with ulcer of left lower extremity. 509 is VALID for claim submission. 1. 25 may differ. Not only are neuropathic ulcers a burden to the patient but also to the economy. Foot ulcers are a common complication in people with diabetes because they are more likely to develop in persons with the disease . Failure to consider. Chronic venous hypertension (idiopathic) with ulcer. 45]; P = 0. 421 became effective on October 1, 2023. Therefore, to assess the efficacy of. Eleven patients with neuroischemic DFU were included in a. Background and Objectives: To propose a new classification of diabetic foot syndrome adapted for inclusion in the ICD-10 (the ICD-10 is the 10th revision of the International Statistical Classification of Diseases) and providing more reliable data on the number of clinical cases. Show details Hide details. 20, 29, 35 The effectiveness of any educational program is critically linked to the availability of complementary clinical. 2,3 If left untreated, foot ulcers can progress to soft tissue infection, gangrene, and limb loss. , a wound penetrating through the dermis at the plantar side of the foot, without reference to time present (21,22). Diabetic foot ulcers (DFUs) are a severe and common complication of diabetes mellitus (DM), with a lifetime incidence that ranges from 15 to 25% among individuals with diabetes [1]. current diabetic foot ulcer (E08. Methods Consecutively presenting patients with diabetes and worst foot ulcer (Wagner grade 1–5, below ankle) (n = 2,511) were prospectively followed and treated. Pressure ulcer of left foot, not stageable; Pressure ulcer of left lower leg, unstageable; Pressure ulcer of lower leg, unstageable; Pressure ulcer of right foot, not stageable; Pressure ulcer of right lower. Routine perfusion assessment detects some degree of PAD in at least 50–60% of DFU patients [10,11]. The economic burden to health care system. Nontraumatic ischemic infarction of muscle of left foot; ICD-10-CM M62. 25 is applicable to adult patients aged 15 - 124 years inclusive. Neuroischemic Diabetic Foot Ulcers / Ndip and Jude 83 management if prevention fails cannot be overem-phasized. Jude. 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. 2013. 006 Corpus ID: 20860603; Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients. 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. The highly complex and integrated process of wound healing is regulated by a large array of. There is now good evidence to support the successful treatment of neuroischemic ulcers with sucrose octasulfate in addition to best-practice standard care ( 59 ). There are principally two types of ‘at-risk’ foot; neuropathic (90%) and neuroischaemic (10%) 1,2,3. The 2024 edition of ICD-10-CM L89. An ulcer’s wound depth is measured in 4 grades going from 0-3, and the presence of ischemia and/or infection is measured in 4 stages from A-D. ICD-9-CM 707. 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 England. Drug or chemical induced diabetes mellitus with foot ulcer. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code (or codes). 509 [convert to ICD-9-CM] Non-pressure chronic ulcer of other part of unspecified foot with unspecified severity See full list on icdlist. Diabetic foot ulceration is a devastating complication of diabetes that is associated with infection, amputation, and death, and is affecting increasing numbers of. 96]; P = 0. 31 In 2a, there were focal increases in StO 2 and decreases in HbT 1 at the initial pre-ulcerative sites on the distal hallux, briefly displaying signatures more consistent with neuropathic. 301. Drug induced diabetes with diabetic foot ulcer; Foot ulcer due to drug induced diabetes mellitus; code to identify site of ulcer (L97. Showing 1-25: ICD-10-CM Diagnosis Code L97. 6. Mitigating this. While all wounds are colonized with microorganisms, the presence of infection is defined by ≥2 classic findings of inflammation or purulence. 4 may differ. [5][12] Assessment of perfusion status and evaluation by a vascular specialist are recommended. , left or right) is introduced, and should be included in the clinical documentation for skin ulcers. Patients who received revascularisation were excluded. Continued on page 72 THE DIABETIC. L97. This is the American ICD-10-CM version of M62. 40: Non-pressure chronic ulcer of unspecified heel and midfoot; L97. DOI: 10. Epidemiologic studies indicate the risk of developing a foot ulcer is 2. }, author={Jan Apelqvist and. 5% per year [2]. Superficial foot ulcer†: An ulcer not penetrating any structure deeper than the dermis. The study group was composed of DFUs patients managed by a limb salvage protocol according to guidance. 515 is grouped within Diagnostic Related Group(s) (MS-DRG v 41. Maggot therapy is sometimes used in debridement, especially with neuroischaemic ulcers. Diabetes Mellitus * E10: Insulin. Non-pressure chronic ulcer of other part of right foot with unspecified severity. Methods: Patients with diabetes with a foot ulcer, consecutively presenting at. L97. The most common underlying etiologic factors responsible for chronic delayed healing among lower extremity wounds encountered in the outpatient clinic are chronic venous insufficiency (CVI), diabetic neuropathy, and arterial insufficiency (AI). Arterial and venous ulcers after local debridement. Diabetic ulcer of left foot with fat layer. Toggle navigation. 622 may differ. Short description: Local infection of the skin and subcutaneous tissue, unsp The 2024 edition of ICD-10-CM L08. Etiology. There. Best answers. Colton Feil Jr. Approximately 15% of individuals with a neuropathic ulcer require limb amputation as a result of infection. Epub 2019 Feb 6 doi:. . In the past few years, there has been a renaissance in diabetic foot care with respect to evidence-based treatments (). In addition, in the work of Gershater et al. Diabetic foot ulcer (DFU) management with a concise algorithm which can be used at the point-of-care. In total there were 13,093 (5. Synonyms: ankle ulcer due to type 2 diabetes mellitus, arteritic. Currently, a specific limb salvage protocol including lower-limb revascularization for managing ischemic diabetic foot ulcers (DFUs) is well established . Ulcer lower extremity 707. Includes concise abstract and comprehensive resources on the condition (e. 2 However, up to 85% of DFUs are associated with neuropathy 3 while between 10. Due to neuropathy, the process. 90 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 103 Non-pressure chronic ulcer of unspecified thi. Although pressure may be a contributing factor, these ulcers are captured as diabetic foot ulcers in the interRAI assessments. 326 may differ. #2. This study aims to evaluate clinical and ulcer characteristics as well the outcomes of patients with diabetic foot ulcers (DFUs). E11. I agree with you. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code L97. Pressure ulcer with abrasion, blister, partial thickness skin loss involving epidermis and/or. A large (3. The ICD-10-CM code E11. due to secondary diabetes 249. For patients with DM, neuroischemic wounds are more commonly found at the foot margins, while neuropathic ulcers tend to form on the plantar surface. 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). Unfortunately, Neurogenic or Neuropathic Ulcer does not have a specific code, or Code Set. 8 per 1,000 person-years (95% CI7. In summary, whereas neuropathy was present in four out of five cases of new foot ulcers in the Reiber study , as noted above, the combination of neuropathy and. 672 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Neuro-ischemic Ulcers on the Medial Side of the Foot. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code L97. 209. 329 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.