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ICD-10 Guide
ICD-10 CodesL89.133

L89.133

Billable

Pressure ulcer of right lower back, stage 3

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

Code Description

ICD-10 L89.133 is a billable code used to indicate a diagnosis of pressure ulcer of right lower back, stage 3.

Key Diagnostic Point:

L89.133 refers to a stage 3 pressure ulcer located on the right lower back. Pressure ulcers, also known as bedsores or decubitus ulcers, occur when sustained pressure on the skin reduces blood flow to the area, leading to tissue damage. Clinically, a stage 3 pressure ulcer is characterized by full-thickness skin loss, where the ulcer extends through the dermis and into the subcutaneous tissue, potentially exposing fat. The right lower back is a common site for these ulcers, particularly in patients with limited mobility or those who are bedridden. Disease progression can lead to further complications, including infection and deeper tissue damage if not properly managed. Diagnostic considerations include a thorough clinical assessment, evaluation of the ulcer's size, depth, and any signs of infection. Healthcare providers must also consider the patient's overall health status, nutritional needs, and mobility limitations to effectively manage and prevent further ulceration.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

Specialty Focus

Medical Specialties

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

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 healthcare costs. They are associated with increased morbidity, prolonged hospital stays, and higher healthcare utilization. Effective management and prevention of pressure ulcers are critical for improving patient outcomes and reducing the burden on healthcare systems. Epidemiologically, pressure ulcers are prevalent in populations with limited mobility, such as the elderly and those with chronic illnesses.

ICD-9 vs ICD-10

Pressure ulcers significantly impact patient quality of life and healthcare costs. They are associated with increased morbidity, prolonged hospital stays, and higher healthcare utilization. Effective management and prevention of pressure ulcers are critical for improving patient outcomes and reducing the burden on healthcare systems. Epidemiologically, pressure ulcers are prevalent in populations with limited mobility, such as the elderly and those with chronic illnesses.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the ulcer, the treatment provided, and any associated complications. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the treatment. Best practices include ensuring that all clinical notes are thorough and that the treatment plan aligns with the documented diagnosis to avoid billing challenges.

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 L89.133?

L89.133 specifically covers stage 3 pressure ulcers on the right lower back, characterized by full-thickness skin loss and potential exposure of subcutaneous fat. It is crucial to differentiate this from other stages of pressure ulcers and other skin conditions.

When should L89.133 be used instead of related codes?

L89.133 should be used when documenting a stage 3 pressure ulcer on the right lower back. It is essential to use this code when the ulcer meets the criteria for stage 3, as using a different stage code could misrepresent the severity of the condition.

What documentation supports L89.133?

Documentation must include a detailed description of the ulcer's characteristics, including its size, depth, and any signs of infection. Additionally, the patient's mobility status, nutritional assessment, and treatment plan should be documented to support the use of L89.133.