L97.926
BillableNon-pressure chronic ulcer of unspecified part of left lower leg with bone involvement without evidence of necrosis
HCC Category Mapping
What This Code Means
A chronic open sore on the left lower leg that is not caused by pressure, with bone involvement but without dead tissue.
Coding Tips
- •Confirm bone involvement without necrosis; this is less severe than L97.924
- •Imaging studies may be needed to document bone involvement
Clinical Significance
This non-pressure chronic ulcer on the unspecified part of left lower leg with viable bone involvement indicates the ulcer has reached bone without causing osteonecrosis, representing a critical window where intervention may prevent bone death. 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 left lower leg
- ✓Laterality documented as left side
- ✓Wound assessment confirming bone involvement/exposure
- ✓Explicit documentation that bone is viable (no necrosis present)
- ✓Imaging studies confirming bone involvement without osteonecrosis
- ✓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