L97.804
BillableNon-pressure chronic ulcer of other part of unspecified lower leg with necrosis of bone
HCC Category Mapping
What This Code Means
A long-lasting open sore on the lower leg (not caused by pressure) where the bone tissue has died and deteriorated.
Coding Tips
- •This is the most severe ulcer category with bone necrosis; confirm bone involvement through imaging or clinical documentation
- •Ensure this is not a pressure ulcer, as those have different coding guidelines
Clinical Significance
This non-pressure chronic ulcer on the other part of unspecified lower leg with bone necrosis represents the most severe form of chronic ulceration, with osteonecrosis indicating potential osteomyelitis and high risk for amputation. 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 unspecified lower leg
- ✓Query provider for laterality if not documented (left vs. right)
- ✓Clinical documentation of bone necrosis (osteonecrosis/osteomyelitis)
- ✓Imaging studies (X-ray, MRI, or bone scan) supporting bone involvement
- ✓Description of necrotic bone tissue characteristics
- ✓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