L97.406
BillableNon-pressure chronic ulcer of unspecified heel and midfoot with bone involvement without evidence of necrosis
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 bone involvement but no dead tissue present.
Coding Tips
- •Verify bone involvement is documented and specifically confirm absence of necrosis to differentiate from L97.404
- •This represents bone damage without tissue death
Clinical Significance
This represents a deep ulcer extending to bone without necrosis, one of the most severe ulcer categories. Bone exposure without necrosis suggests the tissue may still be viable, but the depth of involvement requires urgent specialist evaluation and aggressive management to prevent progression to osteomyelitis or osteonecrosis. 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 bone is involved/exposed in the wound
- ✓Explicit statement that there is NO evidence of bone necrosis
- ✓Imaging studies confirming bone involvement without necrosis
- ✓Assessment for osteomyelitis risk
- ✓Underlying etiology or contributing factors (diabetes, peripheral vascular disease, venous insufficiency)
- ✓Current treatment plan including wound care regimen
Commonly Confused Codes
L97.404 — Bone necrosis at same location; use when bone tissue is necrotic (dead), not just exposedL97.405 — Muscle involvement without necrosis at same location; use when depth reaches muscle but not boneL89.0xx (Pressure ulcer of elbow) / L89.6xx (Pressure ulcer of heel) — Pressure ulcers use the L89 category; L97 is specifically for NON-pressure chronic ulcersL97.416 — Same severity but specified as RIGHT side; use laterality-specific code when documentation supports itL97.426 — 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└L97.406Non-pressure chronic ulcer of unspecified heel and midfoot with bone involvement without evidence of necrosis
└L97.406Non-pressure chronic ulcer of unspecified heel and midfoot with bone involvement without evidence of necrosis