Ulcer HCC Desk Guide: Which L89 and L97 Codes Capture in V28
V28 desk table for L89 and L97 ulcer codes: which last character captures HCC 379-383, the 380 vs 383 split, and E11.621's dual map to 37 and 383.
By the HCC Buddy Coding Team
Updated: August 20, 2026
You opened the chart and the last character is doing all the work. Stage 4 and stage 1 share an L89 family. L97.223 and L97.221 share a site. E11.621 looks like one diabetes code and maps twice. If you treat "ulcer" as one bucket, the V28 payment row is wrong.
Open the member lists on the HCC 379, 380, 381, 382, and 383 cards. Last verified against those CMS files on the cards (reviewed 2026-05-30). This page is the desk table for those cards. It is not an IPPS story, not an NCD story, and not a model-update story.
*Current as of August 20, 2026. Category names, CNA factors, member counts, hierarchy, and every ICD-10-CM example come from the CMS-HCC V28 PY2026 model software and the 2026 Final ICD-10-CM Mappings, as published on the live HCC cards and named code pages. Guideline citations are FY 2026 ICD-10-CM Official Guidelines sections I.C.12.a, I.C.12.b, I.B.14, and I.C.4 only. Verify against the current CMS files before you rely on it.*
Quick answer
Under CMS-HCC V28 for payment year 2026 (100% V28), the last character decides the ulcer HCC. Pressure ulcers in L89 pay by stage. Non-pressure chronic ulcers in L97, L98, and L98.A pay by severity. Some combination codes map to more than one category. A healed ulcer is not a history HCC.
| Last character / code | V28 payment HCC | CNA | Members |
|---|---|---|---|
| L89 stage 4 (last 4) | HCC 379 Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone | 1.965 | 25 |
| L89 stage 3 or unstageable (last 3 or L89.xx0; also L89.45 / L89.95) | HCC 381 Pressure Ulcer of Skin with Full Thickness Skin Loss | 1.075 | 50 |
| L89 stage 2 (last 2) | HCC 382 Pressure Ulcer of Skin with Partial Thickness Skin Loss | 0.838 | 25 |
| L89 stage 1 / DTI / unspecified (L89.151, L89.156, L89.159) | No payment HCC on the live cards | n/a | n/a |
| L97 / L98 / L98.A severity 3 to 6 | HCC 380 Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle | 1.078 | 152 |
| L97 / L98 / L98.A severity 1, 2, 8, 9 | HCC 383 Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle | 0.646 | 308 |
| E11.621 | HCC 37 (0.166) AND HCC 383 (0.646) | both | see cards |
| I70.231 | HCC 263 (1.118); also a 383 member; 263 supersedes 383 | 1.118 | see cards |
| I70.261 | HCC 263 only on the live code page | 1.118 | see card |
| I70.221 | HCC 264 Vascular Disease with Complications | 0.455 | see card |
Hierarchy from the live cards: 379 supersedes 380, 381, 382, 383. 380 supersedes 381, 382, 383. 381 supersedes 382, 383. 382 supersedes 383. 263 also supersedes 383 (and 264 and 409 on the 263 card).
L89: last character is the stage
Do not read L89 as one HCC. The site characters pick sacral, heel, hip, contiguous back-buttock-hip, or unspecified site. The last character picks the stage, and the stage picks the payment row.
Sacral examples from the live cards:
Contiguous back, buttock, and hip:
L89.95 (unspecified site, unstageable) is on the 381 list.
Last-character collision: last 0 means unstageable on the six-character codes (L89.150, L89.000, L89.610). L89.90 also ends in 0. That code is unspecified stage of unspecified site, not unstageable, and it is not a payment HCC. Do not teach "every L89 ending in 0 is 381."
Stage 1, DTI, and unspecified stage are not mapped. They are not "mapped to zero." There is no payment HCC on those live cards.
The pressure ulcer condition page is the L89 staging walk. This table is the last-character cheat sheet that page does not own.
L97 / L98 / L98.A: sixth character is severity
Non-pressure chronic ulcers split on depth, not on L89 stage.
| Sixth character | What the tabular is naming | V28 HCC |
|---|---|---|
| 1, 2, 8, 9 | Limited to breakdown of skin; fat layer exposed; other specified severity; unspecified severity | 383 |
| 3, 4, 5, 6 | Necrosis of muscle; necrosis of bone; muscle involvement without necrosis; bone involvement without necrosis | 380 |
Worked pair from the cards: L97.223 (left calf, necrosis of muscle) → 380. L97.221 (left calf, limited to breakdown of skin) → 383.
L97.xx9 is not unmapped. Unspecified severity still sits on the 383 member list. Code the sixth character the record supports. Do not skip L97.229 because the severity is unspecified.
L98 and L98.A follow the same sixth-character split on the 380 and 383 cards.
E11.621 is 37 and 383
E11.621 (Type 2 diabetes mellitus with foot ulcer) is not an only-383 code. The live code page, the HCC 37 card, the HCC 383 card, and the 2026 Final ICD-10-CM Mappings all assign HCC 37 and HCC 383.
The tabular Use Additional note on E11.621 is L97.4- or L97.5- for site of ulcer. FY 2026 Official Guidelines I.C.4 treat diabetes codes as combination codes: assign as many E08 to E13 codes as needed for the complications the patient has. The L97 pair is the site and severity add-on, not a replacement for E11.621.
If the added L97 sixth character is 3 through 6, the skin-ulcer row can move to 380. HCC 380 supersedes 383. HCC 37 does not move. 37 lives in the diabetes hierarchy (35 and 36 supersede 37; 37 supersedes 38). That is a different group from 379 to 383.
E11.622 (Type 2 diabetes with other skin ulcer) is also on the 383 list and also maps to 37.
Do not code E11.621, skip the L97, and then tell yourself you only captured 383. You captured 37 and 383 if both maps survive. You still owe the L97 when the tabular asks for it.
The diabetes HCC guide is the E11 family walk. The combination-codes post is the broader combination-code rule. This page is the ulcer dual-map desk card those posts do not own.
PAD: rest pain, ulceration, gangrene
Do not flatten I70.2x into one vascular HCC.
The I70.23x Includes notes take in the rest-pain presentation. Once ulceration or gangrene is the supported code for that extremity, do not keep I70.22x as a second atherosclerosis code for the same vessel story. Do not downcode documented gangrene to ulceration. Do not reach 263 from rest pain alone.
263 also supersedes 264 and 409 on the HCC 263 card. Trumping is applied in the model. You do not delete the lower ICD-10 code from the claim to "make" the hierarchy work.
Hierarchy: code the ulcer you have
Trumping inside the skin-ulcer group is one-way and published on the cards.
1. Support the highest category the encounter actually documents.
2. If 379 is clean, 380 to 383 do not add a second payment factor.
3. If 380 is clean and 379 is not, 381 to 383 drop.
4. If 263 is clean, 383 drops even when the same ICD-10 code sits on both lists.
Do not spend the encounter recapturing 382 after 379 is already supported for the year. Do confirm whether the higher category is actually in the note. The hierarchy explainer is the site-wide rulebook. This post is the 379 to 383 / 263 desk card.
Look up the current encounter codes in the encoder before you finalize.
Guidelines vs payment
Cite the section. Do not code from a paraphrase.
I.C.12.a.3 says to query when the stage term is not in the Alphabetic Index and the stage is not documented. I.C.12.a.5 says to query when it is unclear whether the ulcer is current or healing. That is clarification. It is not a request to stage the ulcer higher.
A completely healed ulcer is a no-code rule. It is not a Z-history HCC.
MEAT that makes the row stick
A problem-list row of "sacral ulcer" from last year is not enough. The encounter has to show monitoring, evaluation, assessment, or treatment this visit. See MEAT criteria and problem lists do not validate HCCs. MEAT is the training mnemonic. The authorities are the Official Guidelines and the record from the date of service.
What the note usually needs for L89 / L97 / E11.621 / I70.2x:
Do not query the provider up a stage to "save" 379. Code the stage or severity in the note.
Common misses (no invented audit counts)
1. Skipping stage 2. L89.152 is HCC 382. Stage 2 is a payment HCC in V28.
2. Treating L97.xx9 as unmapped. Unspecified severity is 383.
3. E11.621 without L97, and without both 37 and 383. The live card is a dual map. The tabular still wants L97.4- / L97.5-.
4. Stacking 263 and 383 on I70.231. 263 supersedes 383.
5. Keeping I70.22x after ulceration or gangrene is already the supported atherosclerosis code.
6. Pressure vs diabetic vs arterial mix-up. L89, E11.621 plus L97.4-/L97.5-, and I70.23x / I70.26x are different families.
7. Recapturing 382 after 379 is already supported for the year. The hierarchy will zero 382.
How to check it in two minutes
1. Name the etiology the provider assessed today: pressure, diabetic, arterial, or non-pressure chronic.
2. Assign the ICD-10-CM code from the Tabular and Index. Use I.C.12.a or I.C.12.b for stage or severity. Use I.C.4 plus the E11.621 Use Additional note when diabetes is the combination.
3. Read the last character (L89) or the sixth character (L97/L98/L98.A).
4. Look the code up on HCC Buddy. If it is a 379 to 383 or 263 member, confirm MEAT.
5. Look at the rest of the year: is a higher category in the same group already supported?
6. Model the survivor in the RAF calculator if you need the post-hierarchy factor.
Related
Disclaimer
This article is for professional and educational use only. It is not coding, billing, legal, or medical advice. Verify every code, HCC map, and guideline section against current official CMS, ICD-10-CM, and AHA Coding Clinic guidance and your payer's policy before you assign it. Reading it creates no provider, patient, or advisory relationship.
Mappings and CNA factors are CMS-HCC V28 PY2026, as published on the HCC 379 to 383, 263, 37, and 264 cards (CMS model software and ICD-10-CM mapping file). Guideline sections: FY 2026 ICD-10-CM Official Guidelines I.C.12.a, I.C.12.b, I.B.14, and I.C.4. Not a CMS-HCC model change beyond V28. Not an IPPS or NCD story.
By the HCC Buddy Coding Team.
Sources
HCC 379 card (CNA 1.965, 25 codes, supersedes 380 to 383; last reviewed May 30, 2026)
HCC 380 card (CNA 1.078, 152 codes)
HCC 381 card (CNA 1.075, 50 codes)
HCC 382 card (CNA 0.838, 25 codes)
HCC 383 card (CNA 0.646, 308 codes; trumped by 263, 379 to 382)
HCC 263 card (CNA 1.118; supersedes 264, 383, 409)
HCC 37 card (CNA 0.166; diabetes hierarchy)
E11.621, L89.151, I70.231, I70.261, I70.221
CMS 2026 Model Software / Final ICD-10-CM Mappings
ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026, I.C.12.a, I.C.12.b, I.B.14, I.C.4
Related Tools
Pressure ulcer condition page
L89 staging walk for HCC 379, 381, and 382. This post adds the last-character table and the L97 split.
HCC 379 card
Stage 4 pressure-ulcer members, 1.965 CNA, and the 380-383 hierarchy for CMS-HCC V28 PY2026.
ICD-10 Encoder
Look up the encounter code before you finalize. Confirm the V28 map, not a V24 habit.
RAF Calculator
Model the post-hierarchy survivor when 379, 380, 381, 382, 383, or 263 is in the year.
HCC Buddy Coding Team
Editorial
Every HCC Buddy article is checked against the current CMS-HCC model and the active FY ICD-10-CM tabular release before it publishes.
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