L98.469
L98.469: Non-pressure chronic ulcer of face with unspecified severity
Billable / specific codeICD-10-CM
L98.469 is a billable, specific ICD-10-CM code for non-pressure chronic ulcer of face with unspecified severity. It is valid for submission on a claim.
Check L98.469 with the rest of the claim: free scrubberExcludes2 inherited from the categories above L98.469
Not part of this code, but both may be coded when both are present.
Risk adjustment
L98.469 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
L98.469 is named in 4 Medicare coverage policies: 4 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
Code history
- addedFY2024-FY2027
Non-pressure chronic ulcer of face with unspecified severity
Other codes under L98.46
- L98.461Non-pressure chronic ulcer of face limited to breakdown of skin
- L98.462Non-pressure chronic ulcer of face with fat layer exposed
- L98.463Non-pressure chronic ulcer of face with necrosis of muscle
- L98.464Non-pressure chronic ulcer of face with necrosis of bone
- L98.465Non-pressure chronic ulcer of face with muscle involvement without evidence of necrosis
- L98.466Non-pressure chronic ulcer of face with bone involvement without evidence of necrosis
- L98.468Non-pressure chronic ulcer of face with other specified severity