L97.414
BillableNon-pressure chronic ulcer of right heel and midfoot with necrosis of bone
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 right heel or middle part of the foot that is not caused by pressure, with dead bone tissue visible in the wound.
Coding Tips
- •Bone necrosis represents the most severe category of non-pressure ulcers; confirm bone involvement is documented in clinical notes
- •This severity level often requires specialist consultation and may necessitate surgical intervention
Clinical Significance
This is one of the most severe classifications of non-pressure chronic ulcers, with bone necrosis indicating full-thickness tissue destruction reaching the skeletal level. Bone necrosis (osteonecrosis) carries high risk for osteomyelitis and may require surgical intervention including possible amputation. 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)
- ✓Explicit documentation of bone necrosis (dead/devitalized bone tissue)
- ✓Imaging studies (X-ray, MRI, or bone scan) confirming bone involvement and necrosis
- ✓Assessment for osteomyelitis
- ✓Wound debridement or surgical notes if applicable
- ✓Underlying etiology or contributing factors (diabetes, peripheral vascular disease, venous insufficiency)
- ✓Current treatment plan including wound care regimen
Commonly Confused Codes
L97.416 — Bone involvement WITHOUT necrosis at same location; use when bone is exposed but viableL97.413 — Necrosis of MUSCLE at same location; use when muscle (not bone) shows necrosisL89.0xx (Pressure ulcer of elbow) / L89.6xx (Pressure ulcer of heel) — Pressure ulcers use the L89 category; L97 is specifically for NON-pressure chronic ulcersL97.424 — Same severity but LEFT side; verify laterality matches documentationE11.621 (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└L97.414Non-pressure chronic ulcer of right heel and midfoot with necrosis of bone
└L97.414Non-pressure chronic ulcer of right heel and midfoot with necrosis of bone