L98.A394 ICD-10-CM Code: Non-pressure chronic ulcer of unspecified hand with necrosis of bone
L98.A394 maps to CMS-HCC V28 380. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Other disorders of the skin and subcutaneous tissue (L80-L99)
L98.A394
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNon-pressure chronic ulcer of unspecified hand with necrosis of bone
A long-lasting open wound on a hand (side not specified) with dead bone tissue.
CMS-HCC V28
MappedHCC 380
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 217
Code-level coefficient reference
ESRD/PACE
MappedHCC 161
Code-level coefficient reference
RXHCC
MappedHCC 311
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for L98.A394 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for L98.A394 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for L98.A394 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for L98.A394 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for L98.A394 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for L98.A394 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for L98.A394 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is L98.A394 an HCC code?
Yes. L98.A394 (Non-pressure chronic ulcer of unspecified hand with necrosis of bone) maps to HCC 380, Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 1.078. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: L98.A394 is billable and maps to V28 HCC 380, Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- L98.A394
- Description
- Non-pressure chronic ulcer of unspecified hand with necrosis of bone
- 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 L98.A394 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for L98.A394
For L98.A394 to 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.A394 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
L98.A394 is the ICD-10-CM diagnosis code for non-pressure chronic ulcer of unspecified hand with necrosis of bone. A long-lasting open wound on a hand (side not specified) with dead bone tissue. L98.A394 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.A394 maps to Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle (HCC 380) with a source-labeled community, non-dual, aged reference coefficient of 1.078. No V24 mapping is shown for L98.A394; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Confirm bone necrosis documentation; if hand side is known, use L98.A294 (right) or L98.A324 (left). Because L98.A394 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for L98.A394 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.