L97.101 ICD-10-CM Code: Non-pressure chronic ulcer of unspecified thigh limited to breakdown of skin

Code

L97.101

Description

Non-pressure chronic ulcer of unspecified thigh limited to breakdown of skin

HCC (V28)

HCC 383 — Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle

RAF reference coefficient

0.646

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work L97.101 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for L97.101

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for L97.101 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •This code indicates the least severe stage of non-pressure ulcer with only epidermis and dermis affected
• •Verify the ulcer is not pressure-related and confirm it is on the thigh (not buttock or other location)

Clinical Significance

A non-pressure chronic ulcer of the unspecified thigh with skin breakdown only represents a non-healing wound that has not progressed to deeper tissue involvement. These ulcers typically arise from venous insufficiency, arterial disease, or other chronic conditions, and require ongoing wound management to prevent progression to deeper stages.

Documentation Requirements

• ✓Exact anatomical location with laterality (right, left, or bilateral thigh)
• ✓Etiology of the ulcer (venous insufficiency, peripheral arterial disease, neuropathic, post-traumatic)
• ✓Wound dimensions: length x width in centimeters
• ✓Wound bed description (granulation tissue, slough, drainage characteristics)
• ✓Depth documentation confirming involvement limited to skin or fat layer
• ✓Chronicity documentation — how long the wound has been present
• ✓Vascular assessment if applicable (ankle-brachial index, pulse assessment)
• ✓Current wound care plan (cleansing, dressing type, compression if venous)
• ✓Assessment for signs of infection
• ✓Contributing comorbidities (diabetes mellitus, peripheral vascular disease, venous insufficiency)

Commonly Confused Codes

• •L97.111: Non-pressure chronic ulcer of right thigh, same severity; assign when laterality is documented as right
• •L97.121: Non-pressure chronic ulcer of left thigh, same severity; assign when laterality is documented as left
• •L89.891: Pressure ulcer of other site requires pressure as the etiology, not vascular or other causes
• •L97.9xx: Non-pressure chronic ulcer of unspecified site should not be used for thigh when thigh is documented

Child Codes