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L97.42 ICD-10-CM Code: Non-pressure chronic ulcer of left heel and midfoot

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FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Other disorders of the skin and subcutaneous tissue (L80-L99)

L97.42

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Non-pressure chronic ulcer of left heel and midfoot

Non-pressure chronic ulcer of left heel and midfoot

CMS-HCC V28

0

0

RAF 0

CMS-HCC V24

0

0

RAF 0

ACA/HHS

0

0

RAF 0

ESRD/PACE

0

0

RAF 0

RXHCC

0

0

RAF 0

Code Trumping

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Code Book Path

Official
L97Non-pressure chronic ulcer of lower limb, not elsewhere classified
L97.4Non-pressure chronic ulcer of heel and midfoot
L97.42Non-pressure chronic ulcer of left heel and midfoot

Inclusion Terms

Official
  • Non-pressure chronic ulcer of plantar surface of midfoot

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for L97.42 in this effective period.

Related Child Codes

Official
L97.421Non-pressure chronic ulcer of left heel and midfoot limited to breakdown of skin
L97.422Non-pressure chronic ulcer of left heel and midfoot with fat layer exposed
L97.423Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle
L97.424Non-pressure chronic ulcer of left heel and midfoot with necrosis of bone
L97.425Non-pressure chronic ulcer of left heel and midfoot with muscle involvement without evidence of necrosis

Includes

Official

ICD-10-CM does not list Includes notes for L97.42 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for L97.42 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for L97.42 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for L97.42 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for L97.42 in this effective period.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Coder workflow notes

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What This Code Means

L97.42 is the ICD-10-CM diagnosis code for non-pressure chronic ulcer of left heel and midfoot. L97.42 sits in the ICD-10-CM chapter for diseases of the skin and subcutaneous tissue (l00-l99), within the section covering other disorders of the skin and subcutaneous tissue (l80-l99).

Header codes like L97.42 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at L97.42's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for L97.42 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Child Codes

Code Hierarchy

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