L89.604: Pressure ulcer of unspecified heel, stage 4
L89.604 is a billable, specific ICD-10-CM code for pressure ulcer of unspecified heel, stage 4. It is valid for submission on a claim.
Check L89.604 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 unspecified heel, stage 4
- Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon, or bone, unspecified heel
Excludes2 inherited from the categories above L89.604
Not part of this code, but both may be coded when both are present.
Risk adjustment
L89.604 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
L89.604 is named in 5 Medicare coverage policies: 3 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
- A53064Billing and Coding: Outpatient Occupational Therapy
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under L89.60
- L89.600Pressure ulcer of unspecified heel, unstageable
- L89.601Pressure ulcer of unspecified heel, stage 1
- L89.602Pressure ulcer of unspecified heel, stage 2
- L89.603Pressure ulcer of unspecified heel, stage 3
- L89.606Pressure-induced deep tissue damage of unspecified heel
- L89.609Pressure ulcer of unspecified heel, unspecified stage