What is ICD-10 code L89.134?

L89.134 is the ICD-10-CM diagnosis code for Pressure ulcer of right lower back, stage 4. A stage 4 pressure ulcer on the right lower back that extends through all skin layers and involves muscle, bone, or supporting structures. L89.134 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. L89.134 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. L89.134 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. L89.134 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for L89.134?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For L89.134, V28 maps to Pressure Ulcer of Skin with Full Thickness Skin Loss at RAF 0.662 while V24 mapped to Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone at RAF 1.071. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting L89.134?

Stage 4 is most severe; confirm documentation of exposed bone, muscle, or other deep structures These ulcers require aggressive treatment and carry significant morbidity risk Because L89.134 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

L89.134 ICD-10 Code: Pressure ulcer of right lower

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupL89.134Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Other disorders of the skin and subcutaneous tissue (L80-L99)

L89.134

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Pressure ulcer of right lower back, stage 4

A stage 4 pressure ulcer on the right lower back that extends through all skin layers and involves muscle, bone, or supporting structures.

Buddy Insight

Stage 4 pressure ulcers of the right lower back represent the most severe pressure injury classification with full-thickness tissue loss exposing bone, tendon, muscle, or joint capsule.

CMS-HCC V28

Mapped

HCC 379

Pressure Ulcer of Skin with F...

RAF 0.662

CMS-HCC V24

Mapped

HCC 157

Pressure Ulcer of Skin with N...

RAF 1.071

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 157

Pressure Ulcer of Skin with N...

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

Basket needed

Compare selected patient codes to show trumped or trumps impact.

Code Book Path

Official

L89.1Pressure ulcer of back

L89.13Pressure ulcer of right lower back

L89.134Pressure ulcer of right lower back, stage 4

Inclusion Terms

Official

Healing pressure ulcer of right lower back, stage 4
Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon, or bone, right lower back

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for L89.134 in this effective period.

Related Child Codes

Official

L89.130Pressure ulcer of right lower back, unstageable

L89.131Pressure ulcer of right lower back, stage 1

L89.132Pressure ulcer of right lower back, stage 2

L89.133Pressure ulcer of right lower back, stage 3

L89.136Pressure-induced deep tissue damage of right lower back

Includes

Official

ICD-10-CM does not list Includes notes for L89.134 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for L89.134 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for L89.134 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for L89.134 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for L89.134 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Exact anatomical location specified as right lower back

Stage explicitly documented as stage 4 by the provider

Identification of specific exposed deep structures (bone, muscle, tendon, joint capsule)

Wound dimensions (length x width x depth)

MEAT Support

HCC Buddy guidance

Exact anatomical location specified as right lower back

Stage explicitly documented as stage 4 by the provider

Identification of specific exposed deep structures (bone, muscle, tendon, joint capsule)

Wound dimensions (length x width x depth)

Audit Caution

HCC Buddy guidance

Downcoding to stage 3 when documentation mentions deep wound but does not explicitly state exposed structures — query the provider

Missing concurrent osteomyelitis codes when stage 4 ulcers overlie bony prominences

Not capturing associated sepsis or bacteremia codes when present

Failing to distinguish right lower back from sacral region for accurate site assignment

Common Mistakes

HCC Buddy guidance

L89.133 — Stage 3 right lower back; subcutaneous tissue involved but NO bone/muscle exposure

L89.130 — Unstageable right lower back; wound cannot be staged due to coverage

L89.144 — Stage 4 left lower back; laterality difference

L89.154 — Stage 4 sacral region; different anatomical location

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is L89.134 an HCC code?

Yes. L89.134 maps to Pressure Ulcer of Skin with Full Thickness Skin Loss under the CMS-HCC V28 risk adjustment model (and Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone under V24).

HCC Category Mapping

V28HCC 379, Pressure Ulcer of Skin with Full Thickness Skin Loss

0.662

V24HCC 157, Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone

1.071

ESRDHCC 157, Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for L89.134

For L89.134to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed L89.134 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

L89.134 is the ICD-10-CM diagnosis code for pressure ulcer of right lower back, stage 4. A stage 4 pressure ulcer on the right lower back that extends through all skin layers and involves muscle, bone, or supporting structures. L89.134 sits in the ICD-10-CM chapter for diseases of the skin and subcutaneous tissue (l00-l99), within the section covering other disorders of the skin and subcutaneous tissue (l80-l99).

Under the CMS-HCC V28 risk adjustment model, L89.134 maps to Pressure Ulcer of Skin with Full Thickness Skin Loss (HCC 379) with a community, non-dual, aged base RAF weight of 0.662. Under the older CMS-HCC V24 model, L89.134 maps to Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone (HCC 157) with a community, non-dual, aged base RAF weight of 1.071. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Stage 4 is most severe; confirm documentation of exposed bone, muscle, or other deep structures. Because L89.134 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for L89.134 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Stage 4 is most severe; confirm documentation of exposed bone, muscle, or other deep structures
•These ulcers require aggressive treatment and carry significant morbidity risk

Clinical Significance

Stage 4 pressure ulcers of the right lower back represent the most severe pressure injury classification with full-thickness tissue loss exposing bone, tendon, muscle, or joint capsule. These carry extreme morbidity risk including osteomyelitis, systemic infection, and sepsis. They require intensive multidisciplinary wound management and carry the highest risk adjustment weight among pressure ulcer codes.

Documentation Requirements

✓Exact anatomical location specified as right lower back
✓Stage explicitly documented as stage 4 by the provider
✓Identification of specific exposed deep structures (bone, muscle, tendon, joint capsule)
✓Wound dimensions (length x width x depth)
✓Extent of undermining and tunneling
✓Wound bed tissue type percentages
✓Evidence of complications (osteomyelitis, sepsis, cellulitis)
✓Nutritional labs (albumin, prealbumin)
✓Comprehensive treatment plan including surgical consultation if applicable

Commonly Confused Codes

•L89.133: Stage 3 right lower back; subcutaneous tissue involved but NO bone/muscle exposure
•L89.130: Unstageable right lower back; wound cannot be staged due to coverage
•L89.144: Stage 4 left lower back; laterality difference
•L89.154: Stage 4 sacral region; different anatomical location