L97.215 ICD-10-CM Code: Non-pressure chronic ulcer of right calf with muscle involvement without evidence of necrosis
L97.215 maps to CMS-HCC V28 380 (RAF 1.078). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Other disorders of the skin and subcutaneous tissue (L80-L99)
L97.215
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNon-pressure chronic ulcer of right calf with muscle involvement without evidence of necrosis
A long-lasting open sore on the right calf that is not caused by pressure, with muscle involvement but no dead tissue.
Buddy Insight
Non-pressure chronic ulcers of the lower extremity are significant indicators of underlying vascular disease, diabetes, or other systemic conditions that impair wound healing.
CMS-HCC V28
MappedHCC 380
RAF 1.078
CMS-HCC V24
MappedHCC 161
RAF 0.515
ACA/HHS
MappedHCC 217
Varies by metal level
ESRD/PACE
MappedHCC 161
RAF 0.127
RXHCC
MappedHCC 311
RAF 0.175
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for L97.215 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for L97.215 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for L97.215 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for L97.215 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for L97.215 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for L97.215 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for L97.215 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is L97.215 an HCC code?
Yes. L97.215 (Non-pressure chronic ulcer of right calf with muscle involvement without evidence of necrosis) maps to Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle under the CMS-HCC V28 risk adjustment model (and Chronic Ulcer of Skin, Except Pressure under V24), with a community non-dual aged RAF of 1.078. It is billable for payment year 2026.
Coder answer: L97.215 is billable and maps to V28 HCC 380, Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- L97.215
- Description
- Non-pressure chronic ulcer of right calf with muscle involvement without evidence of necrosis
- HCC (V28)
- HCC 380 — Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle
- RAF
- 1.078
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so 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 segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work L97.215 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for L97.215
For L97.215 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed L97.215 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
Get the V28 RAF + MEAT cheat sheet
One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
L97.215 is the ICD-10-CM diagnosis code for non-pressure chronic ulcer of right calf with muscle involvement without evidence of necrosis. A long-lasting open sore on the right calf that is not caused by pressure, with muscle involvement but no dead tissue. L97.215 sits in the ICD-10-CM chapter for diseases of the skin and subcutaneous tissue (l00-l99), within the section covering other disorders of the skin and subcutaneous tissue (l80-l99).
Under the CMS-HCC V28 risk adjustment model, L97.215 maps to Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle (HCC 380) with a community, non-dual, aged base RAF weight of 1.078. Under the older CMS-HCC V24 model, L97.215 maps to Chronic Ulcer of Skin, Except Pressure (HCC 161) with a community, non-dual, aged base RAF weight of 0.515. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Document muscle involvement without necrosis to differentiate from L97.213. Because L97.215 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for L97.215 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document muscle involvement without necrosis to differentiate from L97.213
- •Confirm muscle is affected but viable (not necrotic)
Clinical Significance
Non-pressure chronic ulcers of the lower extremity are significant indicators of underlying vascular disease, diabetes, or other systemic conditions that impair wound healing. Muscle involvement without necrosis indicates the ulcer extends to muscle tissue that remains viable, representing a serious wound that requires close monitoring to prevent progression to tissue death.
Documentation Requirements
- ✓Ulcer site documented as right calf with clear laterality (right side)
- ✓Confirmation that the ulcer is chronic (present for extended duration, not acute)
- ✓Etiology documented as non-pressure (e.g., venous stasis, arterial insufficiency, diabetic, or other non-pressure cause)
- ✓Clinical assessment of wound depth and tissue involvement
- ✓Documentation that muscle tissue is exposed or involved but remains viable
- ✓Explicit statement that no necrosis of muscle is present
- ✓Wound bed description distinguishing viable muscle from necrotic tissue
Commonly Confused Codes
- •L97.213: necrosis of muscle; muscle tissue death is present
- •L97.212: fat layer exposed; extends through dermis to subcutaneous fat
- •L97.115: left calf; verify laterality before selecting code
- •L89.-: Pressure ulcer codes; use only when ulcer is caused by sustained pressure, not vascular or other non-pressure etiology