L98.472: Non-pressure chronic ulcer of groin with fat layer exposed

Risk adjustment

L98.472 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

L98.472 is named in 8 Medicare coverage policies: 8 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