L98.461

L98.461: Non-pressure chronic ulcer of face limited to breakdown of skin

Billable / specific codeICD-10-CM

L98.461 is a billable, specific ICD-10-CM code for non-pressure chronic ulcer of face limited to breakdown of skin. It is valid for submission on a claim.

Check L98.461 with the rest of the claim: free scrubber

Excludes2 inherited from the categories above L98.461

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

Written on L98.4: Non-pressure chronic ulcer of skin, not elsewhere classified

pressure ulcer (pressure area) (L89.-)
gangrene (I96)
skin infections (L00-L08)
specific infections classified to A00-B99
ulcer of lower limb NEC (L97.-)
varicose ulcer (I83.0-I83.93)

Risk adjustment

L98.461 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 383 Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle0.646 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

L98.461 is named in 6 Medicare coverage policies: 6 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›face›with›skin breakdown only

Code history

addedFY2024-FY2027
Non-pressure chronic ulcer of face limited to breakdown of skin