Pressure Ulcers HCC Coding Guide
Pressure Ulcers (e.g. L89.154) maps to HCC 379 (Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone) under the CMS-HCC V28 risk adjustment model, with a community, non-dual, aged RAF weight of 1.965; V28 reached 100% phase-in for payment year 2026. L89.151, pressure ulcer of sacral region, stage 1, is non-HCC under V28. It can also map to HCC 381 (Pressure Ulcer of Skin with Full Thickness Skin Loss) and HCC 382 (Pressure Ulcer of Skin with Partial Thickness Skin Loss) when the documentation supports those manifestations.
Complete HCC coding guide for Pressure Ulcers (L89.x) including ICD-10 to HCC mapping, V28 RAF weights, staging documentation, and anatomical site coding.
Medically reviewed by Jess P., CPC · Reviewed: May 9, 2026 · Updated for CMS-HCC V28 and FY2026 ICD-10-CM
Quick Facts
HCC Categories
HCC 379, Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone
HCC 381, Pressure Ulcer of Skin with Full Thickness Skin Loss
HCC 382, Pressure Ulcer of Skin with Partial Thickness Skin Loss
RAF Weight Range
0.838 to 1.965
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026, 100% phase-in)
9 ICD-10 codes map to payment HCCs
What HCC category does Pressure Ulcers map to under V28?
Pressure ulcers (also called pressure injuries or decubitus ulcers) are a high-value HCC condition under CMS-HCC V28, and the stage you document drives which category the code lands in. V28 splits pressure ulcers across three severity-based HCCs: stage 4 codes map to HCC 379 (Necrosis Through to Muscle, Tendon, or Bone, community RAF 1.965), stage 3 and unstageable codes map to HCC 381 (Full Thickness Skin Loss, RAF 1.075), and stage 2 codes now map to HCC 382 (Partial Thickness Skin Loss, RAF 0.838). To support these, document the anatomical site, the stage (1 to 4 or unstageable), and laterality where it applies. Follow the NPUAP staging system, record the stage at presentation, and never reverse-stage a healing ulcer once the initial stage is on record.
ICD-10 to HCC Mapping
| ICD-10 Code | Description | Billable | HCC Mapping |
|---|---|---|---|
| L89.154 | Pressure ulcer of sacral region, stage 4 | Yes | HCC 379 |
| L89.153 | Pressure ulcer of sacral region, stage 3 | Yes | HCC 381 |
| L89.014 | Pressure ulcer of right elbow, stage 4 | Yes | HCC 379 |
| L89.024 | Pressure ulcer of left elbow, stage 4 | Yes | HCC 379 |
| L89.214 | Pressure ulcer of right hip, stage 4 | Yes | HCC 379 |
| L89.314 | Pressure ulcer of right buttock, stage 4 | Yes | HCC 379 |
| L89.152 | Pressure ulcer of sacral region, stage 2 | Yes | HCC 382 |
| L89.151 | Pressure ulcer of sacral region, stage 1 | Yes | No HCC (not risk-adjusting under V28) |
| L89.624 | Pressure ulcer of left heel, stage 4 | Yes | HCC 379 |
| L89.95 | Pressure ulcer of unspecified site, unstageable | Yes | HCC 381 |
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS rate announcement for payment calculations.
HCC Buddy maps Pressure Ulcers from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Documentation Tips
Document the specific anatomical site of each pressure ulcer: sacral, coccyx, hip, buttock, heel, elbow, back, etc.
Record the stage at each encounter: stage 1 (non-blanchable erythema), stage 2 (partial thickness), stage 3 (full thickness), stage 4 (through to muscle/bone), or unstageable.
Never reverse-stage a healing pressure ulcer, once staged at 4, it remains coded as stage 4 even as it heals.
Document laterality (right, left) for applicable sites like hips, heels, and elbows.
Record wound measurements (length, width, depth) and characteristics (tunneling, undermining, wound bed description).
Document the treatment plan: wound care protocol, pressure redistribution surfaces, nutritional optimization.
If the ulcer is unstageable due to eschar or slough, code as unstageable rather than guessing the stage beneath.
Common Coding Mistakes
Reverse-staging a healing pressure ulcer (e.g., changing stage 4 to stage 3 as it heals), pressure ulcers should never be downstaged.
Coding stage 1 or 2 pressure ulcers and expecting HCC capture, only stages 3, 4, and unstageable map to payment HCCs in V28.
Not specifying the anatomical site, resulting in 'unspecified site' codes that may still map but lack clinical specificity.
Failing to code multiple pressure ulcers separately when a patient has ulcers at different sites.
V24 to V28 Changes
V28 replaced the older two-category pressure ulcer setup with a three-tier, severity-based hierarchy. Stage 4 ulcers now map to HCC 379 (Necrosis Through to Muscle, Tendon, or Bone), stage 3 and unstageable ulcers map to HCC 381 (Full Thickness Skin Loss), and stage 2 ulcers map to HCC 382 (Partial Thickness Skin Loss). The notable shift for coders is that stage 2 is now a payment HCC under V28, where it previously was not, so do not skip documenting stage 2 ulcers. Stage 1, pressure-induced deep tissue damage, and unspecified-stage codes still carry no payment HCC, which makes precise staging at every encounter essential to accurate risk capture.
Related Conditions
Related references
Sources
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS Rate Announcement for payment.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed May 9, 2026.
Look up Pressure Ulcers codes instantly
HCC Buddy gives you instant ICD-10 to HCC mapping with RAF weights, documentation tips, and Ask Buddy for Pressure Ulcers and 72,000+ other codes.
Get HCC coding tips in your inbox
Weekly updates on coding guidelines, V28 changes, and documentation best practices for risk adjustment professionals.