L97.424

L97.424: Non-pressure chronic ulcer of left heel and midfoot with necrosis of bone

Billable / specific codeICD-10-CMleft

L97.424 is a billable, specific ICD-10-CM code for non-pressure chronic ulcer of left heel and midfoot with necrosis of bone. It is valid for submission on a claim.

Check L97.424 with the rest of the claim: free scrubber

Excludes2 inherited from the categories above L97.424

Not part of this code, but both may be coded when both are present.

Written on L97: Non-pressure chronic ulcer of lower limb, not elsewhere classified

pressure ulcer (pressure area) (L89.-)
skin infections (L00-L08)
specific infections classified to A00-B99

Risk adjustment

L97.424 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 380 Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle1.078 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

L97.424 is named in 16 Medicare coverage policies: 14 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
A52993Billing and Coding: Peripheral Venous Ultrasound
A53057Billing and Coding: Home Health Occupational Therapy

Alphabetic index entries that lead here

Ulcer, ulcerated, ulcerating, ulceration, ulcerative›lower limb›heel›left›with›bone necrosis
Ulcer, ulcerated, ulcerating, ulceration, ulcerative›lower limb›midfoot›left›with›bone necrosis

Code history

Unchanged in every release from FY2024 to FY2027.