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ICD-10 Guide
ICD-10 CodesL89.204

L89.204

Billable

Pressure ulcer of unspecified hip, stage 4

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 L89.204 is a billable code used to indicate a diagnosis of pressure ulcer of unspecified hip, stage 4.

Key Diagnostic Point:

L89.204 refers to a stage 4 pressure ulcer located on the unspecified hip. Pressure ulcers, also known as bedsores or decubitus ulcers, occur due to prolonged pressure on the skin, typically in patients with limited mobility. The skin and subcutaneous tissue undergo progressive damage, leading to full-thickness tissue loss. In stage 4 ulcers, there is extensive destruction, tissue necrosis, and damage to muscle, bone, or supporting structures. Clinically, these ulcers may present with exposed bone or tendon and are often associated with significant pain and risk of infection. The hip region is particularly susceptible due to its bony prominence and the pressure exerted when patients are immobile. Diagnosis involves a thorough clinical examination, assessment of the ulcer's depth, and evaluation of surrounding tissue integrity. Diagnostic imaging may be warranted to assess for underlying osteomyelitis or other complications. Effective management requires a multidisciplinary approach, including wound care, nutritional support, and addressing underlying conditions contributing to immobility.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassification of ulcer stage.
  • Documentation gaps may arise from inadequate assessment of ulcer depth.
  • Billing challenges often stem from the need for detailed wound care documentation.

Specialty Focus

Medical Specialties

Wound Care

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Dermatology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Pressure ulcers, particularly stage 4, have significant clinical implications, leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. They are prevalent in populations with limited mobility, such as the elderly and those with chronic illnesses. Quality measures often include the prevention and management of pressure ulcers, reflecting their impact on patient outcomes and healthcare utilization patterns.

ICD-9 vs ICD-10

Pressure ulcers, particularly stage 4, have significant clinical implications, leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. They are prevalent in populations with limited mobility, such as the elderly and those with chronic illnesses. Quality measures often include the prevention and management of pressure ulcers, reflecting their impact on patient outcomes and healthcare utilization patterns.

Reimbursement & Billing Impact

Reimbursement may be affected by the presence of comorbidities and the complexity of care provided. Common denials can occur if documentation does not clearly support the diagnosis or if the treatment plan is not adequately detailed. Best practices include maintaining thorough records of wound assessments, treatment interventions, and patient progress to ensure compliance with payer requirements.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for L00-L99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for L00-L99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by L89.204?

L89.204 specifically covers stage 4 pressure ulcers on the hip, characterized by full-thickness tissue loss and exposure of underlying structures. It does not include ulcers at other sites or those of lesser stages.

When should L89.204 be used instead of related codes?

L89.204 should be used when documenting a stage 4 pressure ulcer on the hip, particularly when there is evidence of extensive tissue damage. It is crucial to differentiate from stage 3 ulcers (L89.203) based on the depth of tissue loss.

What documentation supports L89.204?

Documentation must include a detailed assessment of the ulcer's stage, location, size, and any signs of infection or complications. Regular updates on the healing process and treatment interventions are also essential.