L97.408
BillableNon-pressure chronic ulcer of unspecified heel and midfoot with other specified severity
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 other specific severity levels not captured by standard categories.
Coding Tips
- •Use this code only when ulcer severity does not fit standard categories and document the specific characteristics
- •Query the provider if possible to determine if a more specific severity code can be assigned
Clinical Significance
This code captures non-pressure chronic ulcers with severity characteristics that do not fit the standard classification categories (skin breakdown through bone necrosis). It is used for atypical presentations requiring specific documentation of the wound severity characteristics. 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)
- ✓Detailed description of the specific severity characteristics that do not fit standard categories
- ✓Clinical rationale for why standard severity codes (skin breakdown, fat exposed, muscle/bone involvement) do not apply
- ✓Underlying etiology or contributing factors (diabetes, peripheral vascular disease, venous insufficiency)
- ✓Current treatment plan including wound care regimen
Commonly Confused Codes
L97.409 — Unspecified severity at same location; use when severity is unknown, not when it is specified but atypicalL97.401 through L97.406 — Standard severity codes at same location; review these before using 'other specified'L89.0xx (Pressure ulcer of elbow) / L89.6xx (Pressure ulcer of heel) — Pressure ulcers use the L89 category; L97 is specifically for NON-pressure chronic ulcersL97.418 — Same severity but specified as RIGHT side; use laterality-specific code when documentation supports itL97.428 — 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└L97.408Non-pressure chronic ulcer of unspecified heel and midfoot with other specified severity
└L97.408Non-pressure chronic ulcer of unspecified heel and midfoot with other specified severity