L97.401
BillableNon-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin
HCC Category Mapping
V28HCC 383 — Diabetic Skin Ulcer and Severe Skin Conditions
0.517V24HCC 161 — Chronic Ulcer of Skin, Except Pressure
0.426ESRDHCC 161 — Chronic Ulcer of Skin, Except Pressure
0.000RxHCCHCC 311 — Diabetic and Chronic Skin Ulcer
0.000What This Code Means
A long-lasting open sore on the heel or midfoot area that is not caused by pressure, with only the outer skin layer broken down.
Coding Tips
- •Confirm the ulcer location is heel or midfoot and that only skin breakdown is present without deeper tissue involvement
- •This represents the least severe category of non-pressure ulcers at this location
Clinical Significance
This represents the earliest stage of non-pressure chronic ulceration, limited to epidermal/dermal disruption. While the least severe classification, it still indicates a chronic wound requiring ongoing management and signals potential for progression to deeper tissue involvement. Accurate laterality documentation (unspecified heel and midfoot) is essential for proper code assignment and tracking wound progression over time.
Documentation Requirements
- ✓Specific anatomic location documented as unspecified heel and midfoot
- ✓Confirmation that the ulcer is non-pressure in etiology (not caused by pressure/immobility)
- ✓Chronicity established — ulcer present for extended duration or described as chronic
- ✓Current wound assessment including size (length x width x depth in centimeters)
- ✓Documentation that ulcer is limited to skin breakdown without deeper tissue involvement
- ✓Wound bed description confirming no exposed subcutaneous tissue, muscle, or bone
- ✓Underlying etiology or contributing factors (diabetes, peripheral vascular disease, venous insufficiency)
- ✓Current treatment plan including wound care regimen
Commonly Confused Codes
L97.402 — Fat layer exposed at same location; use when ulcer has progressed beyond skin to expose subcutaneous fatL97.409 — Unspecified severity at same location; skin breakdown is more specific and preferred when documentedL89.0xx (Pressure ulcer of elbow) / L89.6xx (Pressure ulcer of heel) — Pressure ulcers use the L89 category; L97 is specifically for NON-pressure chronic ulcersL97.411 — Same severity but specified as RIGHT side; use laterality-specific code when documentation supports itL97.421 — Same severity but specified as LEFT side; use laterality-specific code when documentation supports itE11.621 (Type 2 diabetes mellitus with foot ulcer) — If ulcer is due to diabetes, code the diabetic complication first and the L97 code as an additional code to specify site and severity
Code Hierarchy
└L97Non-pressure chronic ulcer of lower limb, not elsewhere classified└L97.4Non-pressure chronic ulcer of heel and midfoot└L97.40Non-pressure chronic ulcer of unspecified heel and midfoot└L97.401Non-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin
└L97.401Non-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin