L97.909
BillableNon-pressure chronic ulcer of unspecified part of unspecified lower leg with unspecified severity
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is L97.909 an HCC code?
Yes. L97.909 maps to Diabetic Skin Ulcer and Severe Skin Conditions under the CMS-HCC V28 risk adjustment model (and Chronic Ulcer of Skin, Except Pressure under V24).
HCC Category Mapping
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 L97.909
For L97.909to 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 L97.909 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
L97.909 is the ICD-10-CM diagnosis code for non-pressure chronic ulcer of unspecified part of unspecified lower leg with unspecified severity. A long-lasting open sore on the lower leg that is not caused by pressure, but the severity level is not specified in the documentation. L97.909 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, L97.909 maps to Diabetic Skin Ulcer and Severe Skin Conditions (HCC 383) with a community, non-dual, aged base RAF weight of 0.517. Under the older CMS-HCC V24 model, L97.909 maps to Chronic Ulcer of Skin, Except Pressure (HCC 161) with a community, non-dual, aged base RAF weight of 0.426. 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.
This is a default code when severity cannot be determined from documentation. Because L97.909 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 L97.909 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a default code when severity cannot be determined from documentation
- •Query the provider if possible to obtain specific severity information for more accurate coding
Clinical Significance
This non-pressure chronic ulcer on the unspecified part of unspecified lower leg with unspecified severity indicates incomplete wound assessment documentation, which limits care coordination and accurate risk stratification. 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 unspecified part of unspecified lower leg
- ✓Query provider for laterality if not documented (left vs. right)
- ✓Note: This is an unspecified code — query provider for severity details when possible
- ✓If severity truly cannot be determined, document the reason
- ✓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
- •L97.901 — skin breakdown — if any severity detail is available, use the specific code instead
- •L97.908 — other specified severity — use when severity is documented but atypical
- •L89.xxx — Pressure ulcer codes; L97 is specifically for NON-pressure chronic ulcers
- •L97.5xx — Foot ulcer codes; verify whether the ulcer is on the leg or foot