L97.412

Billable

Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed

HCC Category Mapping

V28HCC 383 — Diabetic Skin Ulcer and Severe Skin Conditions

0.517

V24HCC 161 — Chronic Ulcer of Skin, Except Pressure

0.426

ESRDHCC 161 — Chronic Ulcer of Skin, Except Pressure

0.000

RxHCCHCC 311 — Diabetic and Chronic Skin Ulcer

0.000

What This Code Means

A long-lasting open sore on the right heel or middle part of the foot that is not caused by pressure, with damage extending through the skin to expose the fatty tissue underneath.

Coding Tips

•This code indicates moderate severity with subcutaneous fat exposure; ensure documentation specifies fat layer involvement
•Differentiate from codes indicating muscle or bone involvement, which represent greater severity

Clinical Significance

This ulcer has progressed beyond skin breakdown to expose the subcutaneous fat layer, indicating moderate wound severity. Fat layer exposure increases infection risk and reflects impaired wound healing that requires more intensive wound care protocols and close monitoring for further tissue deterioration. Accurate laterality documentation (right heel and midfoot) is essential for proper code assignment and tracking wound progression over time.

Documentation Requirements

✓Specific anatomic location documented as right 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 subcutaneous fat layer is visible/exposed in the wound bed
✓Confirmation that deeper structures (muscle, bone) are not involved
✓Underlying etiology or contributing factors (diabetes, peripheral vascular disease, venous insufficiency)
✓Current treatment plan including wound care regimen

Commonly Confused Codes

L97.411 — Limited to skin breakdown at same location; use when ulcer has NOT progressed to fat layer depth L97.413 — Muscle necrosis at same location; use when ulcer has progressed to necrotic muscle tissue L97.415 — Muscle involvement without necrosis at same location; use when ulcer reaches muscle layer 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 ulcers L97.422 — Same severity but LEFT side; verify laterality matches documentation E11.621 (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 └L97.41Non-pressure chronic ulcer of right heel and midfoot └L97.412Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed

└L97.412Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed