L97.425
BillableNon-pressure chronic ulcer of left heel and midfoot with muscle involvement without evidence of necrosis
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 left heel or midfoot that is not caused by pressure, where muscle tissue is involved but not dead.
Coding Tips
- •Distinguish this code from L97.423 by confirming there is NO necrosis documented, only muscle involvement
- •Document the extent of muscle involvement in clinical notes to support medical necessity
Clinical Significance
This ulcer extends to the muscle layer but without evidence of tissue death, indicating deep but potentially viable wound tissue. While serious, the absence of necrosis suggests preserved vascular supply and better potential for healing with appropriate wound care and treatment of underlying conditions. Accurate laterality documentation (left heel and midfoot) is essential for proper code assignment and tracking wound progression over time.
Documentation Requirements
- ✓Specific anatomic location documented as left 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 muscle tissue is involved/exposed in the wound
- ✓Explicit statement that there is NO evidence of muscle necrosis
- ✓Assessment of muscle viability
- ✓Underlying etiology or contributing factors (diabetes, peripheral vascular disease, venous insufficiency)
- ✓Current treatment plan including wound care regimen
Commonly Confused Codes
L97.423 — Muscle necrosis at same location; use when muscle tissue is necrotic (dead), not just involvedL97.426 — Bone involvement without necrosis at same location; use when bone (not muscle) is involvedL97.422 — Fat layer exposed at same location; use when ulcer depth reaches only the fat layerL89.0xx (Pressure ulcer of elbow) / L89.6xx (Pressure ulcer of heel) — Pressure ulcers use the L89 category; L97 is specifically for NON-pressure chronic ulcersL97.415 — Same severity but RIGHT 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└L97.42Non-pressure chronic ulcer of left heel and midfoot└L97.425Non-pressure chronic ulcer of left heel and midfoot with muscle involvement without evidence of necrosis
└L97.425Non-pressure chronic ulcer of left heel and midfoot with muscle involvement without evidence of necrosis