L97.426
BillableNon-pressure chronic ulcer of left heel and midfoot with bone 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 bone tissue is involved but not dead.
Coding Tips
- •Verify bone involvement is present but necrosis is explicitly ruled out or not documented
- •Ensure imaging or clinical documentation supports bone involvement without necrosis
Clinical Significance
This represents a deep ulcer extending to bone without necrosis, one of the most severe ulcer categories. Bone exposure without necrosis suggests the tissue may still be viable, but the depth of involvement requires urgent specialist evaluation and aggressive management to prevent progression to osteomyelitis or osteonecrosis. 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 bone is involved/exposed in the wound
- ✓Explicit statement that there is NO evidence of bone necrosis
- ✓Imaging studies confirming bone involvement without necrosis
- ✓Assessment for osteomyelitis risk
- ✓Underlying etiology or contributing factors (diabetes, peripheral vascular disease, venous insufficiency)
- ✓Current treatment plan including wound care regimen
Commonly Confused Codes
L97.424 — Bone necrosis at same location; use when bone tissue is necrotic (dead), not just exposedL97.425 — Muscle involvement without necrosis at same location; use when depth reaches muscle but not boneL89.0xx (Pressure ulcer of elbow) / L89.6xx (Pressure ulcer of heel) — Pressure ulcers use the L89 category; L97 is specifically for NON-pressure chronic ulcersL97.416 — 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└L97.426Non-pressure chronic ulcer of left heel and midfoot with bone involvement without evidence of necrosis
└L97.426Non-pressure chronic ulcer of left heel and midfoot with bone involvement without evidence of necrosis