This is a diabetic foot ulcer. The patient reportedly went on vacation and noticed this ulcer upon their return. Debridement (removal of damaged tissue) to the level of healthy bleeding tissue is medically necessary as damaged tissue acts an impediment to wound healing. Due to their diabetic neuropathy, they did not feel any pain or indication that a wound was forming. This ulcer appeared to have penetrated to the level of subcutaneous tissue or even fascia, but turned out to be much deeper than that. These are serious wounds and are the beginnings of what lead to foot and leg amputations if they are not treated promptly by your healthcare provider, AKA Podiatrist.