Condition guide
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 CMS-HCC V28. Its source-labeled community non-dual aged reference coefficient is 1.965. This is not a member total; full contribution depends on hierarchy, cleanup, interactions, member context, and model year. 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.
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)
10 ICD-10 codes map to payment HCCs
How coders write it
Chart notes, problem lists, and queries rarely spell out Pressure Ulcers. The shorthand you will actually see:
Whatever the note calls it, the payment question is the same: how the ICD-10-CM code resolves to a payment HCC.
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 |
| L89.150 | Pressure ulcer of sacral region, unstageable | Yes | HCC 381 |
| L89.156 | Pressure-induced deep tissue damage of sacral region | Yes | No HCC (not risk-adjusting under V28) |
| L89.159 | Pressure ulcer of sacral region, unspecified stage | Yes | No HCC (not risk-adjusting under V28) |
Displayed numbers are source-labeled community non-dual aged reference coefficients from CMS-HCC V28, not member totals.
Verify Pressure Ulcers against the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coder workflow notes
Get the V28 mapping + MEAT cheat sheet
A printable reference: representative Pressure Ulcers mappings and the MEAT reminders your notes need. Free, no card.
Free PDF. No card. Unsubscribe anytime.
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.
MEAT documentation examples for Pressure Ulcers
These examples organize documentation review using the MEAT review mnemonic for Pressure Ulcers. Follow the applicable coding, encounter, program and payer requirements; these examples do not establish reportability on their own.
MMonitor
“Sacral pressure ulcer measured 4.2 by 3.1 cm today, down from 4.8 by 3.5 cm two weeks ago.”
“Weekly wound photos reviewed; no new areas of breakdown on heels or hips.”
EEvaluate
“Stage 3: full-thickness loss with visible subcutaneous fat, no bone or tendon exposed; moderate serous drainage, no odor.”
“Braden score 12; albumin 2.9 reviewed.”
AAssess
“Stage 3 pressure ulcer of the sacral region, improving with offloading.”
“Unstageable sacral pressure ulcer with adherent eschar; cannot stage until debrided.”
TTreat
“Continue calcium alginate dressing daily and low-air-loss mattress; turn every two hours.”
“Wound care referral for sharp debridement; dietitian consult for protein supplementation.”
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.
Assuming stage 2 pressure ulcers never earn an HCC, under V28 stage 2 now maps to HCC 382; only stage 1, deep-tissue injury, and unspecified-stage codes carry no payment HCC.
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.
| Aspect | V24 (through PY2025) | V28 (PY2026) |
|---|---|---|
| Stage 4, any site (L89.154, L89.014, L89.624) | HCC 157, Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone, RAF 2.028 | HCC 379, same label, RAF 1.965 |
| Stage 3 and unstageable (L89.153, L89.150, L89.95) | HCC 158, Pressure Ulcer of Skin with Full Thickness Skin Loss, RAF 1.069 | HCC 381, same label, RAF 1.075 |
| Stage 2 (L89.152) | HCC 159, Pressure Ulcer of Skin with Partial Thickness Skin Loss, RAF 0.656 | HCC 382, same label, RAF 0.838 |
| Stage 1, unspecified stage, and deep tissue pressure injury (L89.151, L89.159, L89.156) | No payment HCC | No payment HCC; a stage the provider did not document is a stage that does not pay |
| What actually changed | Three staged categories | Same three labels renumbered; stage 4 came down slightly, stage 2 went up, and the gap between a documented stage and an unspecified stage is the whole category |
These values are community, non-dual, aged code-level coefficient references for each model's payment year, not full member scores. For CMS-HCC V28 PY2026 member scoring with complete context, open the RAF Calculator. No score is shown unless every required source and calculation check passes.
Pressure Ulcers coding FAQs
What HCC category does Pressure Ulcers map to under V28?
Under CMS-HCC V28, Pressure Ulcers maps to 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). The source-labeled community non-dual aged reference coefficient range is 0.838 to 1.965. These coefficients are not member totals; full contribution depends on hierarchy, cleanup, interactions, member context, and model year.
What ICD-10 codes map to HCC for Pressure Ulcers?
Key ICD-10-CM codes for Pressure Ulcers with CMS-HCC V28 mappings include: L89.154 (Pressure ulcer of sacral region, stage 4); L89.153 (Pressure ulcer of sacral region, stage 3); L89.014 (Pressure ulcer of right elbow, stage 4); L89.024 (Pressure ulcer of left elbow, stage 4). HCC Buddy shows the available mapping and documentation guidance, with source-labeled code-level coefficient references on public pages. The RAF Calculator supports CMS-HCC V28 PY2026 with complete member context and shows no score unless every required check passes.
How did V28 change the HCC mapping for Pressure Ulcers?
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.
What documentation is required to code Pressure Ulcers for HCC?
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. For Pressure Ulcers, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. HCC Buddy's condition guides provide documentation checklists for Pressure Ulcers.
What are the ICD-10 guidelines for coding pressure ulcers?
Code the site, laterality, and stage the record supports, one code per ulcer. The stage may come from clinicians other than the provider (wound nurse documentation counts), but the diagnosis of a pressure ulcer must be the provider's. Unstageable (eschar or slough covering the base) is its own code and is not the same as unspecified stage. A pressure ulcer documented as healed is not coded; one documented as healing keeps the stage it was assigned. Under CMS-HCC V28, stage 2 maps to HCC 382, stage 3 and unstageable to HCC 381, and stage 4 to HCC 379.
What is the ICD-10 code for an unspecified pressure ulcer?
L89.90 is pressure ulcer of unspecified site, unspecified stage, and each site has an unspecified-stage code ending in 9 (L89.159 for the sacral region). None of the unspecified-stage codes carries a payment HCC under V28. Unstageable is different: L89.150 (sacral, unstageable) maps to HCC 381 because the wound is full thickness under the eschar.
What is the difference between a pressure ulcer and a non-pressure ulcer?
A pressure ulcer (L89.-) is caused by sustained pressure or shear, usually over a bony prominence. Non-pressure chronic ulcers (L97.- for the lower limb, L98.4- elsewhere) come from vascular disease, diabetes, or other causes and are coded with the underlying condition. V28 keeps them in separate categories: pressure ulcers in HCC 379, 381, and 382 by stage, non-pressure chronic ulcers in HCC 380 or 383 by depth.
How are pressure ulcers staged?
Stage 1 is intact skin with non-blanchable redness; stage 2 is partial-thickness skin loss; stage 3 is full-thickness loss without exposed bone, tendon, or muscle; stage 4 is full-thickness loss with those structures exposed. Unstageable means the base is obscured by eschar or slough, and deep tissue pressure injury (the sixth character 6) is discolored intact skin or a blood-filled blister. The stage in the code must be the stage in the record.
What are two other names for pressure ulcers?
Decubitus ulcer and bedsore are the older terms; pressure injury is the current NPIAP term, and ICD-10-CM keeps the index entries for all of them under pressure ulcer. Whatever the note calls it, the code is the same L89 code for the documented site and stage.
Related Conditions
Related references
Sources
Displayed numbers are source-labeled community non-dual aged reference coefficients from CMS-HCC V28, not member totals.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed September 5, 2026.
Look up Pressure Ulcers codes instantly
HCC Buddy gives you ICD-10 to HCC mapping, documentation tips, CMS-HCC V28 PY2026 calculator, and Ask Buddy for Pressure Ulcers and 74,000+ other codes. Public pages retain source-labeled coefficient references.
Get HCC coding tips in your inbox
Weekly updates on coding guidelines, V28 changes, and documentation best practices for risk adjustment professionals.