L89.154
BillablePressure ulcer of sacral region, stage 4
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is L89.154 an HCC code?
Yes. L89.154 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
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 L89.154
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.
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 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, L89.154 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 the most severe stage with full-thickness tissue loss; document involvement of muscle, bone, tendon, or joint capsule. 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
- •Stage 4 is the most severe stage with full-thickness tissue loss; document involvement of muscle, bone, tendon, or joint capsule
- •Requires detailed clinical assessment and documentation of wound depth, drainage, and any exposed structures
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