L89.45: Pressure ulcer of contiguous site of back, buttock and hip, unstageable
L89.45 is a billable, specific ICD-10-CM code for pressure ulcer of contiguous site of back, buttock and hip, unstageable. It is valid for submission on a claim.
Check L89.45 with the rest of the claim: free scrubberExcludes2 inherited from the categories above L89.45
Not part of this code, but both may be coded when both are present.
Risk adjustment
L89.45 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
L89.45 is named in 9 Medicare coverage policies: 7 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
- A52490Pressure Reducing Support Surfaces - Group 2 - Policy Article
- A53057Billing and Coding: Home Health Occupational Therapy
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
- L89.43Pressure ulcer of contiguous site of back, buttock and hip, stage 3
- L89.44Pressure ulcer of contiguous site of back, buttock and hip, stage 4
- L89.46Pressure-induced deep tissue damage of contiguous site of back, buttock and hip