L97.403
BillableNon-pressure chronic ulcer of unspecified heel and midfoot with necrosis of muscle
HCC Category Mapping
V28HCC 380 — Chronic Ulcer of Skin, Except Pressure
0.426V24HCC 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 dead muscle tissue present.
Coding Tips
- •Verify documentation explicitly states muscle necrosis to distinguish from muscle involvement without necrosis (L97.405)
- •Necrosis indicates tissue death and represents more severe ulcer pathology
Clinical Significance
This represents a severe non-pressure ulcer with necrotic (dead) muscle tissue, indicating significant tissue destruction and compromised vascular supply. Muscle necrosis requires aggressive wound management including debridement and may indicate systemic complications such as peripheral vascular disease or uncontrolled diabetes. 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)
- ✓Explicit documentation of muscle necrosis (dead/devitalized muscle tissue)
- ✓Clinical assessment or pathology confirming necrotic vs. viable muscle tissue
- ✓Wound debridement notes if applicable
- ✓Underlying etiology or contributing factors (diabetes, peripheral vascular disease, venous insufficiency)
- ✓Current treatment plan including wound care regimen
Commonly Confused Codes
L97.405 — Muscle involvement WITHOUT necrosis at same location; use when muscle is involved but viable (no tissue death)L97.404 — Necrosis of BONE at same location; use when bone (not just muscle) shows necrosisL97.402 — Fat layer exposed at same location; use when ulcer has not progressed to muscle depthL89.0xx (Pressure ulcer of elbow) / L89.6xx (Pressure ulcer of heel) — Pressure ulcers use the L89 category; L97 is specifically for NON-pressure chronic ulcersL97.413 — Same severity but specified as RIGHT side; use laterality-specific code when documentation supports itL97.423 — 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└L97.403Non-pressure chronic ulcer of unspecified heel and midfoot with necrosis of muscle
└L97.403Non-pressure chronic ulcer of unspecified heel and midfoot with necrosis of muscle