L97.116 ICD-10-CM Code: Non-pressure chronic ulcer of right thigh with bone involvement without evidence of necrosis

Code

L97.116

Description

Non-pressure chronic ulcer of right thigh with bone involvement without evidence of necrosis

HCC (V28)

HCC 380 — Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle

RAF reference coefficient

1.078

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 L97.116 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for L97.116

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for L97.116 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Confirm bone involvement without necrosis; this is less severe than L97.114
• •Ensure documentation specifies bone exposure or involvement without tissue death

Clinical Significance

A non-pressure chronic ulcer of the right thigh with bone involvement without evidence of necrosis represents a deep, non-healing wound involving structures beyond the subcutaneous tissue. These ulcers typically result from peripheral vascular disease, venous insufficiency, or other systemic conditions, and indicate significant tissue destruction requiring complex wound management.

Documentation Requirements

• ✓Exact anatomical location with laterality (right, left, or bilateral thigh)
• ✓Etiology of the ulcer (venous insufficiency, peripheral arterial disease, neuropathic, post-traumatic, other)
• ✓Wound dimensions: length x width x depth in centimeters
• ✓Documentation of involved structures (muscle, bone, tendon) with or without necrosis
• ✓Wound bed description including percentage of granulation, slough, eschar, and necrotic tissue
• ✓Presence of undermining, tunneling, or sinus tracts with measurements
• ✓Vascular assessment results (ankle-brachial index, duplex ultrasound)
• ✓Current wound care plan including debridement method, dressing type, and frequency
• ✓Signs of infection (cellulitis, osteomyelitis, positive wound cultures)
• ✓Chronicity documentation — duration of wound and treatment history
• ✓Contributing comorbidities (diabetes mellitus, peripheral vascular disease, malnutrition)

Commonly Confused Codes

• •L97.126: Non-pressure chronic ulcer of left thigh, same severity; verify correct laterality
• •L97.106: Non-pressure chronic ulcer of unspecified thigh; use right-specific code when laterality is documented
• •L97.115: Same site with different severity; ensure the correct depth/involvement is coded
• •L89.xxx: Pressure ulcers have different etiology (sustained pressure) and map to different HCC categories

Child Codes