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v1.0.0
ICD-10 Guide
ICD-10 CodesL89.601

L89.601

Billable

Pressure ulcer of unspecified heel, stage 1

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

Code Description

ICD-10 L89.601 is a billable code used to indicate a diagnosis of pressure ulcer of unspecified heel, stage 1.

Key Diagnostic Point:

L89.601 refers to a pressure ulcer of the unspecified heel, classified as stage 1. This stage is characterized by non-blanchable erythema of intact skin, indicating localized redness that does not fade when pressure is relieved. The heel, being a bony prominence, is particularly susceptible to pressure ulcers due to its anatomical structure and the weight-bearing nature of the area. The disease progression of pressure ulcers can escalate from stage 1 to deeper stages if not properly managed, potentially leading to more severe tissue damage and complications such as infections. Diagnostic considerations include a thorough clinical assessment of the skin integrity, patient history, and risk factors such as immobility, nutritional status, and comorbid conditions like diabetes or vascular disease. Early identification and intervention are crucial to prevent progression and promote healing.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires assessment of skin integrity and risk factors.
  • Treatment complexity: Involves multidisciplinary approaches including wound care and possibly surgical intervention.
  • Documentation requirements: Detailed documentation of the ulcer's characteristics and patient history is essential.
  • Coding specificity: Requires precise coding based on the ulcer's stage and location.

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 diagnosis.

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, including stage 1 ulcers, significantly impact patient quality of life and healthcare costs. They are prevalent in populations with limited mobility, such as the elderly and those with chronic illnesses. Effective management of pressure ulcers can reduce hospital stays, improve patient outcomes, and lower healthcare utilization. Monitoring and addressing these conditions are essential for quality measures in healthcare settings, contributing to better overall population health.

ICD-9 vs ICD-10

Pressure ulcers, including stage 1 ulcers, significantly impact patient quality of life and healthcare costs. They are prevalent in populations with limited mobility, such as the elderly and those with chronic illnesses. Effective management of pressure ulcers can reduce hospital stays, improve patient outcomes, and lower healthcare utilization. Monitoring and addressing these conditions are essential for quality measures in healthcare settings, contributing to better overall population health.

Reimbursement & Billing Impact

Reimbursement considerations include the need for comprehensive treatment plans and follow-up assessments. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for treatments. Best practices include maintaining thorough records of patient assessments, treatment interventions, and progress notes to facilitate accurate billing and minimize audit risks.

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 L89.601?

L89.601 specifically covers stage 1 pressure ulcers located on the heel. It is essential to differentiate this from ulcers at other sites or of different stages, as treatment and management may vary significantly.

When should L89.601 be used instead of related codes?

L89.601 should be used when documenting a stage 1 pressure ulcer on the heel. If the ulcer progresses to a deeper stage or occurs in a different location, the appropriate code for that specific condition should be selected.

What documentation supports L89.601?

Documentation should include a detailed description of the ulcer's characteristics, including its stage, location, and any relevant patient history or risk factors. Regular assessments and treatment plans should also be documented to support ongoing management.