L89.104 — Pressure ulcer of unspecified part of back, stage 4
L89.104 is a billable, specific ICD-10-CM code for pressure ulcer of unspecified part of back, stage 4. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Healing pressure ulcer of unspecified part of back, stage 4
- Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon, or bone, unspecified part of back
Excludes2 inherited from the categories above L89.104
Also inherited, and the opposite of Excludes1: these conditions are not part of L89.104, but a patient can have both, so you may code both.
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.
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 of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- 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
Code history
L89.104 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share L89.10. If L89.104 is not quite right, the correct code is usually one of these.
- L89.100Pressure ulcer of unspecified part of back, unstageable
- L89.101Pressure ulcer of unspecified part of back, stage 1
- L89.102Pressure ulcer of unspecified part of back, stage 2
- L89.103Pressure ulcer of unspecified part of back, stage 3
- L89.106Pressure-induced deep tissue damage of unspecified part of back
- L89.109Pressure ulcer of unspecified part of back, unspecified stage
Questions about L89.104
- Is L89.104 a billable ICD-10-CM code?
- Yes. L89.104 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does L89.104 sit in the tabular list?
- Diseases of the skin and subcutaneous tissue (L00-L99), in the block Other disorders of the skin and subcutaneous tissue (L80-L99).