L89.614

Billable

Pressure ulcer of right heel, 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

A stage 4 pressure ulcer on the right heel with full-thickness skin loss extending through all skin layers and involving muscle, bone, or supporting structures.

Coding Tips

•Stage 4 is the most severe; document exposure of muscle, bone, tendon, or joint capsule
•Ensure clear documentation of depth and structures involved to justify this highest stage

Clinical Significance

A stage 4 pressure ulcer of the right heel is the most severe stage, with full thickness tissue loss exposing bone, tendon, or muscle. These wounds carry the highest morbidity risk including osteomyelitis, sepsis, and significant mortality, demanding complex interdisciplinary wound care. Stage 4 pressure ulcers have the highest risk adjustment impact in this category, mapping to V28 HCC 379 (RAF 0.662) and V24 HCC 157 (RAF 1.071), reflecting the extreme clinical complexity and cost of care.

Documentation Requirements

✓Exact anatomical location with laterality
✓Explicit staging as stage 4 by the treating provider
✓Documentation of exposed structures (bone, tendon, muscle, joint capsule)
✓Wound dimensions: length x width x depth in centimeters
✓Presence and measurements of undermining, tunneling, or sinus tracts
✓Wound bed description including necrotic tissue, slough, granulation tissue percentages
✓Wound drainage characteristics (type, volume, color, odor)
✓Signs of infection or osteomyelitis (bone involvement, positive cultures)
✓Comprehensive treatment plan including surgical consultation, debridement, negative pressure wound therapy, flap/graft considerations
✓Nutritional assessment with albumin/prealbumin levels and dietary interventions
✓Pressure redistribution strategy (specialty mattress, turning schedule, offloading devices)

Commonly Confused Codes

L89.613 — Stage 3 of right heel has subcutaneous tissue visible but NO exposed bone, tendon, or muscle L89.610 — Unstageable of right heel means the wound base is covered by slough or eschar M86.x — Osteomyelitis should be coded separately when documented as complication of stage 4 pressure ulcer L97.xxx — Non-pressure chronic ulcers have different etiology (venous, arterial, diabetic); verify pressure as the cause

Code Hierarchy

└L89Pressure ulcer └L89.6Pressure ulcer of heel └L89.61Pressure ulcer of right heel └L89.614Pressure ulcer of right heel, stage 4

└L89.614Pressure ulcer of right heel, stage 4