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ICD-10 Guide
ICD-10 CodesL89.43

L89.43

Billable

Pressure ulcer of contiguous site of back, buttock and hip, stage 3

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

Code Description

ICD-10 L89.43 is a billable code used to indicate a diagnosis of pressure ulcer of contiguous site of back, buttock and hip, stage 3.

Key Diagnostic Point:

L89.43 refers to a stage 3 pressure ulcer located on contiguous sites of the back, buttock, and hip. 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 fascia, muscle, or bone. The ulcer may present with slough or necrotic tissue, and the depth can vary based on the anatomical site. The back, buttock, and hip are common areas for pressure ulcers due to prolonged pressure, especially in individuals with limited mobility or those who are bedridden. Disease progression can lead to further complications, including infection, which may necessitate surgical intervention. Diagnostic considerations include a thorough assessment of the ulcer's size, depth, and surrounding tissue condition, along with patient history to identify risk factors such as immobility, malnutrition, and comorbidities. Proper staging and documentation are crucial for effective treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium 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 insufficient detail on ulcer assessment.
  • Billing challenges can occur if treatment plans are not well-documented.

Specialty Focus

Medical Specialties

Wound care specialists

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

Dermatologists

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 3 ulcers, have significant clinical implications, affecting patient quality of life and increasing healthcare costs. They are prevalent in populations with limited mobility, such as the elderly and those with chronic illnesses. Effective management and prevention strategies are crucial for reducing incidence rates, improving patient outcomes, and minimizing healthcare utilization associated with complications from these ulcers.

ICD-9 vs ICD-10

Pressure ulcers, particularly stage 3 ulcers, have significant clinical implications, affecting patient quality of life and increasing healthcare costs. They are prevalent in populations with limited mobility, such as the elderly and those with chronic illnesses. Effective management and prevention strategies are crucial for reducing incidence rates, improving patient outcomes, and minimizing healthcare utilization associated with complications from these ulcers.

Reimbursement & Billing Impact

Reimbursement considerations include the need for detailed clinical notes that outline the ulcer's characteristics and the treatment plan. Common denials may arise from insufficient documentation or incorrect coding of the ulcer stage. Best practices include regular updates on the patient's condition and adherence to coding guidelines to avoid discrepancies during audits.

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 L89.43?

L89.43 covers stage 3 pressure ulcers specifically located on the back, buttock, and hip. These ulcers are characterized by full-thickness skin loss and may have necrotic tissue but do not involve underlying structures.

When should L89.43 be used instead of related codes?

L89.43 should be used when a pressure ulcer is confirmed as stage 3 on the specified anatomical sites. It is important to differentiate it from stage 2 (L89.42) and stage 4 (L89.44) ulcers based on the depth of tissue loss.

What documentation supports L89.43?

Documentation should include a detailed description of the ulcer's size, depth, and characteristics, along with patient risk factors and treatment plans. Regular assessments and updates on healing progress are also essential.