L97.418
BillableNon-pressure chronic ulcer of right 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 right heel or middle part of the foot that is not caused by pressure, with a severity level not captured by other specific codes.
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 atypicalL97.411 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 ulcersL97.428 — 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└L97.418Non-pressure chronic ulcer of right heel and midfoot with other specified severity
└L97.418Non-pressure chronic ulcer of right heel and midfoot with other specified severity