L97.525 ICD-10-CM Code: Non-pressure chronic ulcer of other part of left foot with muscle involvement without evidence of necrosis

Code

L97.525

Description

Non-pressure chronic ulcer of other part of left foot with muscle involvement without evidence of necrosis

HCC (V28)

HCC 380 — Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle

RAF reference coefficient

1.078

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work L97.525 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for L97.525

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for L97.525 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Muscle is involved but viable (not necrotic); this is less severe than L97.523
• •Ensure documentation confirms muscle layer involvement without necrosis

Clinical Significance

This non-pressure chronic ulcer on the other part of left foot with viable muscle involvement indicates deep tissue penetration without active tissue death, suggesting the wound is severe but potentially salvageable with aggressive wound care. Chronic non-pressure ulcers are significant for risk adjustment because they indicate ongoing complex wound management needs, increased healthcare utilization, and often reflect underlying systemic conditions such as peripheral vascular disease, diabetes mellitus, or venous insufficiency. Accurate severity coding directly impacts care planning, specialist referral decisions, and appropriate resource allocation for wound care services.

Documentation Requirements

• ✓Confirmation that the ulcer is chronic (present for extended duration, not acute)
• ✓Documentation that the ulcer is NOT caused by pressure (non-pressure etiology)
• ✓Specific anatomical site of the ulcer on the other part of left foot
• ✓Laterality documented as left side
• ✓Wound assessment confirming muscle layer involvement
• ✓Explicit documentation that muscle tissue is viable (no necrosis present)
• ✓Description of wound depth extending to but not destroying muscle
• ✓Underlying etiology or contributing conditions (e.g., venous insufficiency, arterial disease, diabetes mellitus, neuropathy)
• ✓Current wound measurements (length, width, depth) and wound bed description
• ✓Current treatment plan and wound care management

Commonly Confused Codes

• •L97.515: Right foot equivalent; verify laterality documentation carefully
• •L97.523: muscle necrosis: this code requires necrosis (tissue death) to be present
• •L97.522: fat layer exposed: less deep, does not involve muscle
• •L89.xxx: Pressure ulcer codes; L97 is specifically for NON-pressure chronic ulcers
• •L97.8xx: Lower leg ulcer codes; verify whether the ulcer is on the foot or leg

Child Codes