Pressure Ulcers HCC Coding Guide
Complete HCC coding guide for Pressure Ulcers (L89.x) including ICD-10 to HCC mapping, V28 RAF weights, staging documentation, and anatomical site coding.
Quick Facts
HCC Categories
HCC 381 — Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone
HCC 382 — Pressure Ulcer of Skin with Full Thickness Skin Loss
RAF Weight Range
0.296 – 0.535
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026 — 100% phase-in)
8 ICD-10 codes map to payment HCCs
Overview
Pressure ulcers (also called pressure injuries or decubitus ulcers) are a significant HCC condition under CMS-HCC V28, particularly for stage 3, stage 4, and unstageable pressure ulcers. Approximately 2.5 million patients develop pressure ulcers annually in the US. Under V28, severe pressure ulcers map to HCC 381 (Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone). Coding requires documenting the specific anatomical site, the stage (1-4 or unstageable), and laterality when applicable. The staging of pressure ulcers follows the NPUAP staging system, and the stage at presentation should be documented — pressure ulcers are never reverse-staged once the initial stage is documented.
ICD-10 to HCC Mapping
| ICD-10 Code | Description | Billable | HCC Mapping |
|---|---|---|---|
| L89.154 | Pressure ulcer of sacral region, stage 4 | Yes | HCC 381 |
| L89.153 | Pressure ulcer of sacral region, stage 3 | Yes | HCC 382 |
| L89.014 | Pressure ulcer of right elbow, stage 4 | Yes | HCC 381 |
| L89.024 | Pressure ulcer of left elbow, stage 4 | Yes | HCC 381 |
| L89.214 | Pressure ulcer of right hip, stage 4 | Yes | HCC 381 |
| L89.314 | Pressure ulcer of right buttock, stage 4 | Yes | HCC 381 |
| L89.152 | Pressure ulcer of sacral region, stage 2 | Yes | No HCC |
| L89.151 | Pressure ulcer of sacral region, stage 1 | Yes | No HCC |
| L89.624 | Pressure ulcer of left heel, stage 4 | Yes | HCC 381 |
| 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.
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 created a severity-based hierarchy for pressure ulcers with HCC 381 (Necrosis Through to Muscle, Tendon, or Bone — stages 4/unstageable) and HCC 382 (Full Thickness Skin Loss — stage 3). Under V24, pressure ulcers mapped to HCC 157 (Pressure Ulcer of Skin with Full Thickness Skin Loss) and HCC 158. V28 recalibrated the weights and clarified the staging-to-HCC mapping. Stage 1 and 2 pressure ulcers remain non-payment HCCs in V28.
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