What is ICD-10 code L97.221?

L97.221 is the ICD-10-CM diagnosis code for Non-pressure chronic ulcer of left calf limited to breakdown of skin. A long-lasting open sore on the left calf that is not caused by pressure, affecting only the outer layer of skin. L97.221 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. L97.221 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. L97.221 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. L97.221 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.

What is the V28 vs V24 difference for L97.221?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For L97.221, V28 maps to Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle at RAF 0.646 while V24 mapped to Chronic Ulcer of Skin, Except Pressure at RAF 0.515. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting L97.221?

This represents the least severe stage of non-pressure ulcers; confirm no deeper tissue involvement Document the etiology (venous, arterial, diabetic, or other) separately for complete coding Because L97.221 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM L97.221: Non-pressure chronic ulcer

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupL97.221Effective 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)

L97.221

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

Non-pressure chronic ulcer of left calf limited to breakdown of skin

A long-lasting open sore on the left calf that is not caused by pressure, affecting only the outer layer of skin.

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...

RAF 0.646

CMS-HCC V24

Mapped

HCC 161

Chronic Ulcer of Skin, Except...

RAF 0.515

ACA/HHS

Mapped

HCC 217

HHS-HCC 217

Varies by metal level

ESRD/PACE

Mapped

HCC 161

Chronic Ulcer of Skin, Except...

RAF 0.127

RXHCC

Mapped

HCC 311

Diabetic and Chronic Skin Ulcer

RAF 0.175

Code Book Path

Official

L97.2Non-pressure chronic ulcer of calf

L97.22Non-pressure chronic ulcer of left calf

L97.221Non-pressure chronic ulcer of left calf limited to breakdown of skin

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for L97.221 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for L97.221 in this effective period.

Related Child Codes

Official

L97.222Non-pressure chronic ulcer of left calf with fat layer exposed

L97.223Non-pressure chronic ulcer of left calf with necrosis of muscle

L97.224Non-pressure chronic ulcer of left calf with necrosis of bone

L97.225Non-pressure chronic ulcer of left calf with muscle involvement without evidence of necrosis

L97.226Non-pressure chronic ulcer of left calf with bone involvement without evidence of necrosis

Includes

Official

ICD-10-CM does not list Includes notes for L97.221 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for L97.221 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for L97.221 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for L97.221 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for L97.221 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Ulcer site documented as left calf with clear laterality (left 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 left calf with clear laterality (left 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 left 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)

Undercoding by selecting unspecified severity (7th character 9) when skin breakdown is clearly documented

Overcoding to fat layer exposed (7th character 2) when documentation only supports superficial skin involvement

Common Mistakes

HCC Buddy guidance

L97.222 — fat layer exposed; extends through dermis to subcutaneous fat

L97.229 — unspecified severity; depth/severity not documented

L97.121 — right 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 L97.221 an HCC code?

Yes. L97.221 (Non-pressure chronic ulcer of left calf limited to breakdown of skin) maps to Chronic Ulcer of Skin, Except Pressure, Not Specified as 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 0.646. It is billable for payment year 2026.

Coder answer: L97.221 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: L97.221
Description: Non-pressure chronic ulcer of left calf limited to breakdown of skin
HCC (V28): HCC 383 — Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle
RAF: 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

V24HCC 161, Chronic Ulcer of Skin, Except Pressure

0.515

ESRDHCC 161, Chronic Ulcer of Skin, Except Pressure

0.127

RxHCCHCC 311, Diabetic and Chronic Skin Ulcer

0.175

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 L97.221 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for L97.221

For L97.221 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 L97.221 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

L97.221 is the ICD-10-CM diagnosis code for non-pressure chronic ulcer of left calf limited to breakdown of skin. A long-lasting open sore on the left calf that is not caused by pressure, affecting only the outer layer of skin. L97.221 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, L97.221 maps to Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle (HCC 383) with a community, non-dual, aged base RAF weight of 0.646. Under the older CMS-HCC V24 model, L97.221 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.

This represents the least severe stage of non-pressure ulcers; confirm no deeper tissue involvement. Because L97.221 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 L97.221 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This represents the least severe stage of non-pressure ulcers; confirm no deeper tissue involvement
•Document the etiology (venous, arterial, diabetic, or other) separately for complete 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. This code captures the least severe stage with only superficial skin breakdown, but it still signals an active chronic wound requiring ongoing management and monitoring for progression to deeper tissue involvement.

Documentation Requirements

✓Ulcer site documented as left calf with clear laterality (left 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 ulcer is limited to skin breakdown only — no exposure of deeper tissue layers
✓Wound measurements (length, width, depth) confirming superficial involvement
✓Assessment for signs of infection or progression beyond skin layer

Commonly Confused Codes

•L97.222: fat layer exposed; extends through dermis to subcutaneous fat
•L97.229: unspecified severity; depth/severity not documented
•L97.121: right 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