L89.300
BillablePressure ulcer of unspecified buttock, unstageable
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is L89.300 an HCC code?
Yes. L89.300 maps to Pressure Ulcer of Skin, Unstageable/Unspecified under the CMS-HCC V28 risk adjustment model (and Pressure Ulcer of Skin with Full Thickness Skin Loss 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 L89.300
For L89.300 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 L89.300 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
L89.300 is the ICD-10-CM diagnosis code for pressure ulcer of unspecified buttock, unstageable. A pressure ulcer on an unspecified buttock that cannot be staged due to the presence of eschar (dead tissue) or slough covering the wound. L89.300 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, L89.300 maps to Pressure Ulcer of Skin, Unstageable/Unspecified (HCC 381) with a community, non-dual, aged base RAF weight of 0.000. Under the older CMS-HCC V24 model, L89.300 maps to Pressure Ulcer of Skin with Full Thickness Skin Loss (HCC 158) with a community, non-dual, aged base RAF weight of 0.662. 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.
Unstageable ulcers are typically covered with necrotic tissue; document the reason for being unstageable (eschar, slough, etc.). Because L89.300 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 L89.300 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Unstageable ulcers are typically covered with necrotic tissue; document the reason for being unstageable (eschar, slough, etc.)
- •When eschar is removed or slough is debrided, reassess and recode to the appropriate stage if possible
Clinical Significance
Unstageable pressure ulcers of the unspecified buttock indicate wound beds that cannot be assessed due to eschar or slough coverage, with additional documentation deficiency regarding laterality. The buttocks are high-risk pressure ulcer sites in seated and supine patients. Unstageable wounds may harbor stage 3 or 4 depth beneath the wound covering, necessitating aggressive debridement planning.
Documentation Requirements
- ✓Anatomical location specified as buttock (query for laterality)
- ✓Clinical reason for unstageable designation
- ✓Description of wound covering (eschar type, slough characteristics)
- ✓Wound dimensions if assessable
- ✓Patient positioning and support surface documentation
- ✓Debridement plan
- ✓Reassessment timeline for staging and laterality documentation