L97.418 ICD-10-CM Code: Non-pressure chronic ulcer of right heel and midfoot with other specified severity

Code

L97.418

Description

Non-pressure chronic ulcer of right heel and midfoot with other specified severity

HCC (V28)

HCC 383 — Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle

RAF reference coefficient

0.646

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work L97.418 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for L97.418

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for L97.418 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Use this code only when the documented severity does not fit standard categories; include specific documentation of the severity in the medical record
• •Avoid using this code if a more specific severity code applies

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 (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)
• ✓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

• •L97.419: Unspecified severity at same location; use when severity is unknown, not when it is specified but atypical
• •L97.411 through L97.416: 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 ulcers
• •L97.428: 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

Child Codes