L89.104: Pressure ulcer of unspecified part of back, stage 4

Risk adjustment

L89.104 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 379 Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone1.965 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

L89.104 is named in 6 Medicare coverage policies: 4 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which one applies depends on your Medicare contractor.

• A56566Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
• A57067Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
• A52468Pressure Reducing Support Surfaces - Group 3- Policy Article
• A52490Pressure Reducing Support Surfaces - Group 2 - Policy Article