L98.413
L98.413: Non-pressure chronic ulcer of buttock with necrosis of muscle
Billable / specific codeICD-10-CM
L98.413 is a billable, specific ICD-10-CM code for non-pressure chronic ulcer of buttock with necrosis of muscle. It is valid for submission on a claim.
Check L98.413 with the rest of the claim: free scrubberExcludes2 inherited from the categories above L98.413
Not part of this code, but both may be coded when both are present.
Risk adjustment
L98.413 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
L98.413 is named in 10 Medicare coverage policies: 10 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A53057Billing and Coding: Home Health Occupational Therapy
- A53058Billing and Coding: Home Health Physical Therapy
- A53064Billing and Coding: Outpatient Occupational Therapy
- A53065Billing and Coding: Outpatient Physical Therapy
Alphabetic index entries that lead here
- Ulcer, ulcerated, ulcerating, ulceration, ulcerative›buttock›with›muscle necrosis
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under L98.41
- L98.411Non-pressure chronic ulcer of buttock limited to breakdown of skin
- L98.412Non-pressure chronic ulcer of buttock with fat layer exposed
- L98.414Non-pressure chronic ulcer of buttock with necrosis of bone
- L98.415Non-pressure chronic ulcer of buttock with muscle involvement without evidence of necrosis
- L98.416Non-pressure chronic ulcer of buttock with bone involvement without evidence of necrosis
- L98.418Non-pressure chronic ulcer of buttock with other specified severity
- L98.419Non-pressure chronic ulcer of buttock with unspecified severity