L98.451 ICD-10-CM Code: Non-pressure chronic ulcer of neck limited to breakdown of skin
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Other disorders of the skin and subcutaneous tissue (L80-L99)
L98.451
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNon-pressure chronic ulcer of neck limited to breakdown of skin
A long-lasting open wound on the neck that is not caused by pressure and only affects the outer layer of skin.
CMS-HCC V28
MappedHCC 383
RAF 0.517
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 161
RAF 0.0
RXHCC
MappedHCC 311
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for L98.451 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for L98.451 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for L98.451 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for L98.451 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for L98.451 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for L98.451 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for L98.451 in this effective period.
Buddy Documentation Tip
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 L98.451 an HCC code?
Yes. L98.451 maps to Diabetic Skin Ulcer and Severe Skin Conditions under the CMS-HCC V28 risk adjustment model.
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 L98.451
For L98.451to 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 L98.451 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
L98.451 is the ICD-10-CM diagnosis code for non-pressure chronic ulcer of neck limited to breakdown of skin. A long-lasting open wound on the neck that is not caused by pressure and only affects the outer layer of skin. L98.451 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, L98.451 maps to Diabetic Skin Ulcer and Severe Skin Conditions (HCC 383) with a community, non-dual, aged base RAF weight of 0.517. L98.451 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. 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.
Confirm the ulcer is limited to skin breakdown with no deeper tissue involvement. Because L98.451 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 L98.451 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm the ulcer is limited to skin breakdown with no deeper tissue involvement
- •Verify location is neck (not chest or other body part) to ensure correct code selection