L89.43: Pressure ulcer of contiguous site of back, buttock and hip, stage 3
L89.43 is a billable, specific ICD-10-CM code for pressure ulcer of contiguous site of back, buttock and hip, stage 3. It is valid for submission on a claim.
Check L89.43 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Healing pressure ulcer of contiguous site of back, buttock and hip, stage 3
- Pressure ulcer with full thickness skin loss involving damage or necrosis of subcutaneous tissue, contiguous site of back, buttock and hip
Excludes2 inherited from the categories above L89.43
Not part of this code, but both may be coded when both are present.
Risk adjustment
L89.43 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 381 Pressure Ulcer of Skin with Full Thickness Skin Loss1.075 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
L89.43 is named in 12 Medicare coverage policies: 10 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
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under L89.4
- L89.40Pressure ulcer of contiguous site of back, buttock and hip, unspecified stage
- L89.41Pressure ulcer of contiguous site of back, buttock and hip, stage 1
- L89.42Pressure ulcer of contiguous site of back, buttock and hip, stage 2
- L89.44Pressure ulcer of contiguous site of back, buttock and hip, stage 4
- L89.45Pressure ulcer of contiguous site of back, buttock and hip, unstageable
- L89.46Pressure-induced deep tissue damage of contiguous site of back, buttock and hip