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ICD-10 Guide
ICD-10 CodesL89.219

L89.219

Billable

Pressure ulcer of right hip, unspecified stage

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

Code Description

ICD-10 L89.219 is a billable code used to indicate a diagnosis of pressure ulcer of right hip, unspecified stage.

Key Diagnostic Point:

L89.219 refers to a pressure ulcer located on the right hip, classified as unspecified stage. Pressure ulcers, also known as bedsores or decubitus ulcers, occur due to prolonged pressure on the skin, often in individuals with limited mobility. The right hip is a common site for these ulcers due to the bony prominence and the pressure exerted when sitting or lying down. Clinically, these ulcers can present as localized areas of skin breakdown, which may vary in appearance from non-blanchable erythema to full-thickness tissue loss. The disease progression can lead to serious complications, including infections, which may require surgical intervention. Diagnostic considerations include a thorough patient history, physical examination, and assessment of risk factors such as immobility, malnutrition, and moisture exposure. Accurate staging of pressure ulcers is crucial for treatment planning and prognosis, although L89.219 indicates that the specific stage is unspecified, which may complicate management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires assessment of ulcer stage and underlying conditions.
  • Treatment complexity: May involve multidisciplinary approaches including wound care, nutritional support, and possibly surgical intervention.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment.
  • Coding specificity: The unspecified stage may lead to challenges in coding and billing.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcer stage or site.
  • Documentation gaps: Incomplete records regarding the ulcer's characteristics and treatment plan.
  • Billing challenges: Potential denials due to lack of specificity in documentation.

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 increased healthcare utilization, including hospitalizations and extended care. They are prevalent in vulnerable populations, such as the elderly and those with chronic illnesses. Addressing pressure ulcers is critical for improving patient outcomes, reducing healthcare costs, and meeting quality measures in clinical practice.

ICD-9 vs ICD-10

Pressure ulcers significantly impact patient quality of life and can lead to increased healthcare utilization, including hospitalizations and extended care. They are prevalent in vulnerable populations, such as the elderly and those with chronic illnesses. Addressing pressure ulcers is critical for improving patient outcomes, reducing healthcare costs, and meeting quality measures in clinical practice.

Reimbursement & Billing Impact

Reimbursement considerations include the need for detailed records of the ulcer's characteristics, treatment plans, and any associated comorbidities. Common denials may arise from insufficient documentation or failure to specify the ulcer stage. Best practices include ensuring that all clinical notes are complete and that the treatment provided aligns with the diagnosis to avoid billing discrepancies.

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 L89.219?

L89.219 covers pressure ulcers located on the right hip, which may arise from immobility, friction, shear forces, or moisture. It is essential to assess the ulcer's characteristics to determine the appropriate treatment and management plan.

When should L89.219 be used instead of related codes?

L89.219 should be used when a pressure ulcer on the right hip is documented but the specific stage is not identified. If the stage is known, more specific codes should be utilized to ensure accurate representation of the patient's condition.

What documentation supports L89.219?

Documentation should include a detailed description of the ulcer's location, size, appearance, and any associated symptoms. Additionally, the patient's mobility status, nutritional assessment, and treatment plan should be clearly outlined to support the diagnosis.