L89.44

Billable

Pressure ulcer of contiguous site of back, buttock and hip, stage 4

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

What This Code Means

The most severe pressure wound (bedsore) affecting the lower back, buttocks, or hip area with damage extending through all skin layers into muscle, bone, or supporting structures.

Coding Tips

•Confirm stage 4 documentation explicitly states involvement of muscle, bone, tendon, or joint capsule
•Document the contiguous nature of the ulcer affecting multiple anatomical sites in the back/buttock/hip region

Clinical Significance

Stage 4 pressure ulcers of the contiguous site of back, buttock, and hip represent the most devastating wound pattern, with full-thickness tissue loss and deep structure exposure spanning multiple connected anatomical areas. These massive wounds carry the highest morbidity and mortality risk among all pressure ulcers, often requiring multiple surgical procedures and prolonged intensive care. They indicate catastrophic failure of pressure prevention measures.

Documentation Requirements

✓Documentation that the pressure ulcer spans contiguous areas of back, buttock, and hip
✓Stage explicitly documented as stage 4
✓Specific exposed structures at each involved area
✓Total wound dimensions across all sites
✓Undermining and tunneling measurements at each area
✓Imaging for osteomyelitis across exposed bony areas
✓Wound and bone cultures
✓Comprehensive nutritional assessment and labs
✓Surgical consultation for reconstructive planning
✓Multi-disciplinary treatment plan
✓Prognosis documentation

Commonly Confused Codes

L89.43 — Stage 3 contiguous site; NO deep structure exposure L89.45 — Unstageable contiguous site; wound bed obscured L89.154 — Stage 4 sacral region; single-site ulcer L89.304 — Stage 4 unspecified buttock; single-site ulcer

Code Hierarchy

└L89Pressure ulcer └L89.4Pressure ulcer of contiguous site of back, buttock and hip └L89.44Pressure ulcer of contiguous site of back, buttock and hip, stage 4

└L89.44Pressure ulcer of contiguous site of back, buttock and hip, stage 4