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L89.154 ICD-10-CM Code: Pressure ulcer of sacral region, stage 4

L89.154 maps to CMS-HCC V28 379 (RAF 1.965). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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

L89.154

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

Pressure ulcer of sacral region, stage 4

A stage 4 pressure ulcer on the sacral region representing the most severe type, with damage extending through all skin layers into muscle, bone, or other deep structures.

Buddy the Bee presenting code insight

Buddy Insight

Stage 4 sacral pressure ulcers are among the most serious wound care challenges encountered in healthcare.

CMS-HCC V28

HCC 379

RAF 1.965

CMS-HCC V24

HCC 157

RAF 2.028

ACA/HHS

N/A

—

Not mapped

ESRD/PACE

HCC 157

RAF 0.219

RXHCC

N/A

—

Not mapped

Code Book Path

Official
L89.1Pressure ulcer of back
L89.15Pressure ulcer of sacral region
L89.154Pressure ulcer of sacral region, stage 4

Inclusion Terms

Official
  • Healing pressure ulcer of sacral region, stage 4
  • Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon, or bone, sacral region

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for L89.154 in this effective period.

Related Child Codes

Official
L89.150Pressure ulcer of sacral region, unstageable
L89.151Pressure ulcer of sacral region, stage 1
L89.152Pressure ulcer of sacral region, stage 2
L89.153Pressure ulcer of sacral region, stage 3
L89.156Pressure-induced deep tissue damage of sacral region

Includes

Official

ICD-10-CM does not list Includes notes for L89.154 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for L89.154 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for L89.154 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for L89.154 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for L89.154 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Anatomical location specified as sacral region
Stage explicitly documented as stage 4
Specific structures exposed (sacral bone, muscle, ligament)
Complete wound dimensions including depth

MEAT Support

HCC Buddy guidance
Anatomical location specified as sacral region
Stage explicitly documented as stage 4
Specific structures exposed (sacral bone, muscle, ligament)
Complete wound dimensions including depth

Audit Caution

HCC Buddy guidance
Failing to code concurrent osteomyelitis when sacral bone is exposed — query provider and review imaging
Downcoding to stage 3 when documentation describes deep wound over the sacrum but does not explicitly mention exposed bone
Missing sepsis or bacteremia codes associated with infected stage 4 sacral wounds
Not coding associated malnutrition that is nearly universally present with stage 4 sacral wounds

Common Mistakes

HCC Buddy guidance
L89.153 — Stage 3 sacral region; subcutaneous tissue involved but NO bone/muscle exposure
L89.150 — Unstageable sacral region; wound bed obscured
L89.304 — Stage 4 unspecified buttock; different anatomical site
L89.44 — Stage 4 contiguous site of back, buttock, and hip; use when ulcer spans multiple areas

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is L89.154 an HCC code?

Yes. L89.154 (Pressure ulcer of sacral region, stage 4) maps to Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone under the CMS-HCC V28 risk adjustment model (and Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone under V24), with a community non-dual aged RAF of 1.965. It is billable for payment year 2026.

Coder answer: L89.154 is billable and maps to V28 HCC 379, Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
L89.154
Description
Pressure ulcer of sacral region, stage 4
HCC (V28)
HCC 379 — Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone
RAF
1.965
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 379, Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone
1.965
V24HCC 157, Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone
2.028
ESRDHCC 157, Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone
0.219

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work L89.154 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for L89.154

For L89.154 to 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 L89.154 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

L89.154 is the ICD-10-CM diagnosis code for pressure ulcer of sacral region, stage 4. A stage 4 pressure ulcer on the sacral region representing the most severe type, with damage extending through all skin layers into muscle, bone, or other deep structures. L89.154 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, L89.154 maps to Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone (HCC 379) with a community, non-dual, aged base RAF weight of 1.965. Under the older V24 model, L89.154 mapped to the same category but with a base RAF weight of 2.028, V28 recalibrated weights across the entire model. 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.

Pressure ulcer of sacral region, stage 4, full-thickness skin loss with exposed bone, tendon, or muscle. Sacral stage 4 pressure ulcers are common in bedridden patients. Because L89.154 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 L89.154 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Pressure ulcer of sacral region, stage 4, full-thickness skin loss with exposed bone, tendon, or muscle. Sacral stage 4 pressure ulcers are common in bedridden patients.
  • •Wound-care documentation must specifically identify exposed deep structures. A stage 3 upgraded to stage 4 because of new deep-tissue exposure is common on longitudinal review.
  • •V28 HCC 379 at RAF 1.965.

Clinical Significance

Stage 4 sacral pressure ulcers are among the most serious wound care challenges encountered in healthcare. The sacrum's minimal soft tissue coverage means stage 4 wounds frequently involve exposed sacral bone with high risk for osteomyelitis. These wounds carry significant mortality risk, require extensive resources, and often necessitate surgical intervention including flap procedures. They represent the highest acuity pressure ulcer designation.

Documentation Requirements

  • ✓Anatomical location specified as sacral region
  • ✓Stage explicitly documented as stage 4
  • ✓Specific structures exposed (sacral bone, muscle, ligament)
  • ✓Complete wound dimensions including depth
  • ✓Undermining and tunneling measurements
  • ✓Wound bed tissue assessment
  • ✓Bone biopsy or imaging results for osteomyelitis assessment
  • ✓Wound culture results if infection suspected
  • ✓Nutritional labs (albumin, prealbumin, transferrin)
  • ✓Surgical consultation and operative plan if applicable
  • ✓Comprehensive wound care regimen

Commonly Confused Codes

  • •L89.153: Stage 3 sacral region; subcutaneous tissue involved but NO bone/muscle exposure
  • •L89.150: Unstageable sacral region; wound bed obscured
  • •L89.304: Stage 4 unspecified buttock; different anatomical site
  • •L89.44: Stage 4 contiguous site of back, buttock, and hip; use when ulcer spans multiple areas

Child Codes

L89.150Pressure ulcer of sacral region, unstageable
HCC 381
L89.151Pressure ulcer of sacral region, stage 1
L89.152Pressure ulcer of sacral region, stage 2
HCC 382
L89.153Pressure ulcer of sacral region, stage 3
HCC 381
L89.154Pressure ulcer of sacral region, stage 4
HCC 379
L89.156Pressure-induced deep tissue damage of sacral region
L89.159Pressure ulcer of sacral region, unspecified stage

Code Hierarchy

└L89Pressure ulcer└L89.1Pressure ulcer of back└L89.15Pressure ulcer of sacral region└L89.154Pressure ulcer of sacral region, stage 4
└L89.154Pressure ulcer of sacral region, stage 4

Because L89.154 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.

L89.154 maps to CMS-HCC V28 category 379, Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because L89.154 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

More on L89.154

Related condition guides

Referenced in blog posts

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