L89.112 — Pressure ulcer of right upper back, stage 2

Risk adjustment

L89.112 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 382 Pressure Ulcer of Skin with Partial Thickness Skin Loss0.838 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

L89.112 is named in 11 Medicare coverage policies — 9 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
• A52490Pressure Reducing Support Surfaces - Group 2 - Policy Article
• A53057Billing and Coding: Home Health Occupational Therapy