L97.409
BillableNon-pressure chronic ulcer of unspecified heel and midfoot with unspecified 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 middle part of the foot that is not caused by pressure, affecting an unspecified foot with unknown severity.
Coding Tips
- •This code is used when the specific foot (left or right) and severity level are not documented; request clarification from the provider before coding
- •Verify whether this is truly a non-pressure ulcer, as pressure ulcers use different code categories (L89)
Clinical Significance
This code is used when the severity of the non-pressure chronic ulcer is not specified in the clinical documentation. While it maps to an HCC, coders should query providers for severity details to enable more specific code selection and better clinical documentation. 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)
- ✓Provider query attempted for severity details (if available)
- ✓Note: This code should be used only when severity truly cannot be determined from documentation
- ✓Underlying etiology or contributing factors (diabetes, peripheral vascular disease, venous insufficiency)
- ✓Current treatment plan including wound care regimen
Commonly Confused Codes
L97.401 through L97.406 — Specific severity codes at same location; always query provider for severity before defaulting to unspecifiedL97.408 — Other specified severity at same location; use when severity IS documented but does not fit standard categoriesL89.0xx (Pressure ulcer of elbow) / L89.6xx (Pressure ulcer of heel) — Pressure ulcers use the L89 category; L97 is specifically for NON-pressure chronic ulcersL97.419 — Same severity but specified as RIGHT side; use laterality-specific code when documentation supports itL97.429 — 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└L97.409Non-pressure chronic ulcer of unspecified heel and midfoot with unspecified severity
└L97.409Non-pressure chronic ulcer of unspecified heel and midfoot with unspecified severity