What is ICD-10 code L97.513?

L97.513 is the ICD-10-CM diagnosis code for Non-pressure chronic ulcer of other part of right foot with necrosis of muscle. A long-lasting open sore on the right foot (not from pressure) where muscle tissue is dead, affecting an area other than the heel or sole. L97.513 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. L97.513 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. L97.513 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. L97.513 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for L97.513?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For L97.513, V28 maps to Chronic Ulcer of Skin, Except Pressure at RAF 0.426 while V24 mapped to Chronic Ulcer of Skin, Except Pressure at RAF 0.426. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting L97.513?

Verify documentation explicitly states muscle necrosis (death); distinguish from muscle involvement without necrosis (L97.515) Confirm right foot and non-heel/non-sole location Because L97.513 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

L97.513 ICD-10 Code: Non-pressure chronic ulcer

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupL97.513Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

L97.513

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Non-pressure chronic ulcer of other part of right foot with necrosis of muscle

A long-lasting open sore on the right foot (not from pressure) where muscle tissue is dead, affecting an area other than the heel or sole.

Buddy Insight

This represents a severe non-pressure ulcer with necrotic (dead) muscle tissue, indicating significant tissue destruction and compromised vascular supply.

CMS-HCC V28

Mapped

HCC 380

Chronic Ulcer of Skin, Except...

RAF 0.426

CMS-HCC V24

Mapped

HCC 161

Chronic Ulcer of Skin, Except...

RAF 0.426

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 161

Chronic Ulcer of Skin, Except...

RAF 0.0

RXHCC

Mapped

HCC 311

Diabetic and Chronic Skin Ulcer

RAF 0.0

Code Trumping

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Compare selected patient codes to show trumped or trumps impact.

Code Book Path

Official

L97.5Non-pressure chronic ulcer of other part of foot

L97.51Non-pressure chronic ulcer of other part of right foot

L97.513Non-pressure chronic ulcer of other part of right foot with necrosis of muscle

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for L97.513 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for L97.513 in this effective period.

Related Child Codes

Official

L97.511Non-pressure chronic ulcer of other part of right foot limited to breakdown of skin

L97.512Non-pressure chronic ulcer of other part of right foot with fat layer exposed

L97.514Non-pressure chronic ulcer of other part of right foot with necrosis of bone

L97.515Non-pressure chronic ulcer of other part of right foot with muscle involvement without evidence of necrosis

L97.516Non-pressure chronic ulcer of other part of right foot with bone involvement without evidence of necrosis

Includes

Official

ICD-10-CM does not list Includes notes for L97.513 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for L97.513 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for L97.513 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for L97.513 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for L97.513 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Specific anatomic location documented as other part of right foot

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)

MEAT Support

HCC Buddy guidance

Specific anatomic location documented as other part of right foot

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)

Audit Caution

HCC Buddy guidance

Confusing non-pressure ulcers (L97) with pressure ulcers (L89) — verify the etiology is NOT pressure/immobility-related before assigning L97 codes

Confusing muscle involvement with muscle necrosis — necrosis specifically means tissue death; muscle involvement without necrosis uses a different 7th character

Failing to distinguish between muscle necrosis and bone necrosis — verify which tissue type is necrotic

Failing to code the underlying cause (diabetes, peripheral vascular disease, venous insufficiency) — L97 codes often require an additional etiology code per ICD-10-CM guidelines

Common Mistakes

HCC Buddy guidance

L97.515 — Muscle involvement WITHOUT necrosis at same location; use when muscle is involved but viable (no tissue death)

L97.514 — Necrosis of BONE at same location; use when bone (not just muscle) shows necrosis

L97.512 — Fat layer exposed at same location; use when ulcer has not progressed to muscle depth

L89.xxx (Pressure ulcer codes) — Pressure ulcers use the L89 category; L97 is specifically for NON-pressure chronic ulcers

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.

Is L97.513 an HCC code?

Yes. L97.513 maps to Chronic Ulcer of Skin, Except Pressure under the CMS-HCC V28 risk adjustment model (and Chronic Ulcer of Skin, Except Pressure under V24).

HCC Category Mapping

V28HCC 380, Chronic Ulcer of Skin, Except Pressure

0.426

V24HCC 161, Chronic Ulcer of Skin, Except Pressure

0.426

ESRDHCC 161, Chronic Ulcer of Skin, Except Pressure

0.000

RxHCCHCC 311, Diabetic and Chronic Skin Ulcer

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for L97.513

For L97.513to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed L97.513 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

L97.513 is the ICD-10-CM diagnosis code for non-pressure chronic ulcer of other part of right foot with necrosis of muscle. A long-lasting open sore on the right foot (not from pressure) where muscle tissue is dead, affecting an area other than the heel or sole. L97.513 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).

Under the CMS-HCC V28 risk adjustment model, L97.513 maps to Chronic Ulcer of Skin, Except Pressure (HCC 380) with a community, non-dual, aged base RAF weight of 0.426. The V24 model used during the PY2024–PY2025 transition mapped L97.513 the same way and at the same RAF weight. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Verify documentation explicitly states muscle necrosis (death); distinguish from muscle involvement without necrosis (L97.515). Because L97.513 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for L97.513 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify documentation explicitly states muscle necrosis (death); distinguish from muscle involvement without necrosis (L97.515)
•Confirm right foot and non-heel/non-sole location

Clinical Significance

This represents a severe non-pressure ulcer with necrotic (dead) muscle tissue, indicating significant tissue destruction and compromised vascular supply. Muscle necrosis requires aggressive wound management including debridement and may indicate systemic complications such as peripheral vascular disease or uncontrolled diabetes. Accurate laterality documentation (right other part of foot) is essential for proper code assignment and tracking wound progression over time.

Documentation Requirements

✓Specific anatomic location documented as other part of right foot
✓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)
✓Explicit documentation of muscle necrosis (dead/devitalized muscle tissue)
✓Clinical assessment or pathology confirming necrotic vs. viable muscle tissue
✓Wound debridement notes if applicable
✓Underlying etiology or contributing factors (diabetes, peripheral vascular disease, venous insufficiency)
✓Current treatment plan including wound care regimen

Commonly Confused Codes

•L97.515: Muscle involvement WITHOUT necrosis at same location; use when muscle is involved but viable (no tissue death)
•L97.514: Necrosis of BONE at same location; use when bone (not just muscle) shows necrosis
•L97.512: Fat layer exposed at same location; use when ulcer has not progressed to muscle depth
•L89.xxx (Pressure ulcer codes): Pressure ulcers use the L89 category; L97 is specifically for NON-pressure chronic ulcers
•L97.523: 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