L89.814

Billable

Pressure ulcer of head, 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 severe pressure ulcer (bedsore) on the head that has progressed to stage 4, meaning it has penetrated through the skin and underlying tissues, potentially exposing bone or muscle.

Coding Tips

•Stage 4 pressure ulcers represent full-thickness skin loss with extensive tissue damage; ensure clinical documentation clearly describes the depth and extent of tissue involvement
•Specify the exact location on the head (e.g., scalp, ear, face) if documented, as this may affect treatment planning and prognosis

Clinical Significance

A stage 4 pressure ulcer of the head 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

L89.813 — Stage 3 of head has subcutaneous tissue visible but NO exposed bone, tendon, or muscle L89.810 — Unstageable of head 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 └L89.8Pressure ulcer of other site └L89.81Pressure ulcer of head └L89.814Pressure ulcer of head, stage 4

└L89.814Pressure ulcer of head, stage 4