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ICD-10 Guide
ICD-10 CodesL89.213

L89.213

Billable

Pressure ulcer of right hip, stage 3

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

Code Description

ICD-10 L89.213 is a billable code used to indicate a diagnosis of pressure ulcer of right hip, stage 3.

Key Diagnostic Point:

L89.213 refers to a stage 3 pressure ulcer located on the right hip. Pressure ulcers, also known as bedsores or decubitus ulcers, occur due to prolonged pressure on the skin, often in patients with limited mobility. Clinically, a stage 3 pressure ulcer is characterized by full-thickness skin loss, which may extend into the subcutaneous tissue but does not involve underlying muscle, fascia, or bone. The ulcer may present with necrotic tissue and may have drainage. The right hip is a common site for pressure ulcers due to the bony prominence and the pressure exerted when a patient is in a supine position. Disease progression can lead to more severe stages if not properly managed, potentially resulting in infections and systemic complications. Diagnostic considerations include a thorough clinical assessment, documentation of the ulcer's size, depth, and any signs of infection. Regular monitoring and assessment are crucial for effective management and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires assessment of ulcer stage and potential complications.
  • Treatment complexity: Involves multidisciplinary care including wound care specialists.
  • Documentation requirements: Detailed documentation of ulcer characteristics and treatment progress is necessary.
  • Coding specificity: Requires precise coding to reflect the stage and location of the ulcer.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcer stage or location.
  • Documentation gaps: Incomplete records regarding ulcer assessment and treatment.
  • Billing challenges: Potential denials if documentation does not support the severity or treatment provided.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: Wound care management

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 significantly impact patient quality of life and can lead to serious complications, including infections and increased healthcare costs. They are prevalent in populations with limited mobility, such as the elderly and those with chronic illnesses. Effective management of pressure ulcers is crucial for improving patient outcomes and reducing healthcare utilization, as they can lead to extended hospital stays and increased morbidity.

ICD-9 vs ICD-10

Pressure ulcers significantly impact patient quality of life and can lead to serious complications, including infections and increased healthcare costs. They are prevalent in populations with limited mobility, such as the elderly and those with chronic illnesses. Effective management of pressure ulcers is crucial for improving patient outcomes and reducing healthcare utilization, as they can lead to extended hospital stays and increased morbidity.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the ulcer and the complexity of care required. Common denials may occur if documentation does not clearly support the diagnosis or if the treatment plan is not adequately outlined. Best practices include maintaining thorough records of assessments, treatment interventions, and patient progress to facilitate claims processing and reduce the risk of denials.

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 L89.213?

L89.213 specifically covers stage 3 pressure ulcers located on the right hip. This includes ulcers that have full-thickness skin loss and may involve necrotic tissue but do not extend into muscle or bone.

When should L89.213 be used instead of related codes?

L89.213 should be used when documenting a stage 3 pressure ulcer on the right hip. It is important to differentiate this code from stage 1 or 2 ulcers, or ulcers located on different body parts, to ensure accurate coding and appropriate treatment.

What documentation supports L89.213?

Documentation should include a detailed description of the ulcer's characteristics, including size, depth, presence of necrotic tissue, and any signs of infection. Regular assessments and treatment plans should also be documented to support the coding.