What is ICD-10 code L97.219?

L97.219 is the ICD-10-CM diagnosis code for Non-pressure chronic ulcer of right calf with unspecified severity. A long-lasting open sore on the right calf that is not caused by pressure, with the severity level not specified in the medical record. L97.219 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. L97.219 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. L97.219 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. L97.219 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does L97.219 map to under V28?

L97.219 maps to CMS-HCC V28 HCC 383 (Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM L97.219: Non-pressure chronic ulcer

L97.219 maps to CMS-HCC V28 383. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupL97.219Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Other disorders of the skin and subcutaneous tissue (L80-L99)

L97.219

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Non-pressure chronic ulcer of right calf with unspecified severity

A long-lasting open sore on the right calf that is not caused by pressure, with the severity level not specified in the medical record.

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

Mapped

HCC 383

Chronic Ulcer of Skin, Except...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 217

HHS-HCC 217 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 161

Chronic Ulcer of Skin/Except ...

Code-level coefficient reference

RXHCC

Mapped

HCC 311

Chronic Ulcer of Skin, Except...

Code-level coefficient reference

Code Book Path

Official

L97.2Non-pressure chronic ulcer of calf

L97.21Non-pressure chronic ulcer of right calf

L97.219Non-pressure chronic ulcer of right calf with unspecified severity

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for L97.219 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for L97.219 in this effective period.

Related Child Codes

Official

L97.211Non-pressure chronic ulcer of right calf limited to breakdown of skin

L97.212Non-pressure chronic ulcer of right calf with fat layer exposed

L97.213Non-pressure chronic ulcer of right calf with necrosis of muscle

L97.214Non-pressure chronic ulcer of right calf with necrosis of bone

L97.215Non-pressure chronic ulcer of right calf with muscle involvement without evidence of necrosis

Includes

Official

ICD-10-CM does not list Includes notes for L97.219 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for L97.219 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for L97.219 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for L97.219 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for L97.219 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Failing to verify laterality — documentation must specify right calf; do not assume based on previous encounters

Coding a pressure ulcer code (L89.-) when the ulcer is actually non-pressure in etiology (venous, arterial, diabetic)

Accepting unspecified severity without querying the provider — always attempt to obtain the specific depth and tissue involvement

Using unspecified as a convenience code when documentation actually supports a specific severity level

Common Mistakes

HCC Buddy guidance

L97.211 — limited to breakdown of skin; skin breakdown only — no deeper tissue involvement

L97.218 — other specified severity; severity documented but not fitting standard categories

L97.119 — 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

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 L97.219 an HCC code?

Yes. L97.219 (Non-pressure chronic ulcer of right calf with unspecified severity) maps to HCC 383, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.646. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: L97.219 is billable and maps to V28 HCC 383, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: L97.219
Description: Non-pressure chronic ulcer of right calf with unspecified severity
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

V28HCC 383, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle

0.646

ESRDHCC 161, Chronic Ulcer of Skin/Except Pressure

Not separately weighted

RxHCCHCC 311, Chronic Ulcer of Skin, Except Pressure

Not separately weighted

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 L97.219 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for L97.219

For L97.219 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 L97.219 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

L97.219 is the ICD-10-CM diagnosis code for non-pressure chronic ulcer of right calf with unspecified severity. A long-lasting open sore on the right calf that is not caused by pressure, with the severity level not specified in the medical record. L97.219 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, L97.219 maps to Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle (HCC 383) with a source-labeled community, non-dual, aged reference coefficient of 0.646. No V24 mapping is shown for L97.219; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Query the provider if severity details are available in documentation, as this code indicates missing specificity. Because L97.219 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for L97.219 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Query the provider if severity details are available in documentation, as this code indicates missing specificity
•Ensure this is documented as non-pressure related (venous, arterial, or diabetic) before coding

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. While the severity is unspecified, the presence of any chronic non-pressure ulcer at this site is clinically meaningful and should prompt query for specificity to ensure accurate severity capture.

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
✓Query provider for specific depth and tissue involvement to improve code specificity
✓Document why severity could not be determined if assessment was limited

Commonly Confused Codes

•L97.211: limited to breakdown of skin; skin breakdown only: no deeper tissue involvement
•L97.218: other specified severity; severity documented but not fitting standard categories
•L97.119: 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