Pressure ulcer of sacral region, stage 3
ICD-10 L89.153 is a billable code used to indicate a diagnosis of pressure ulcer of sacral region, stage 3.
L89.153 refers to a stage 3 pressure ulcer located in the sacral region, which is characterized by full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. Clinically, these ulcers present as a deep crater with possible undermining of adjacent tissue. The sacral region is particularly susceptible due to prolonged pressure, often seen in patients with limited mobility, such as those in long-term care or post-operative settings. The progression of a pressure ulcer can be influenced by factors such as moisture, friction, and nutritional status. Diagnosis typically involves a thorough clinical examination, including assessment of the ulcer's size, depth, and any signs of infection. Accurate staging is crucial for effective treatment planning and monitoring of healing. Healthcare providers must be vigilant in documenting the ulcer's characteristics and any interventions undertaken to prevent further deterioration.
Standard ICD-10-CM documentation requirements apply
Various clinical presentations within this specialty area
Follow specialty-specific billing guidelines
Standard ICD-10-CM documentation requirements apply
Various clinical presentations within this specialty area
Follow specialty-specific billing guidelines
L89.153 specifically covers stage 3 pressure ulcers in the sacral region, which are defined by full-thickness skin loss with damage to subcutaneous tissue. It is critical to differentiate this from stage 1 and stage 2 ulcers, which involve less tissue damage.
L89.153 should be used when the pressure ulcer is confirmed to be stage 3 and located in the sacral region. It is important to use this code rather than L89.152 (stage 2) or L89.151 (stage 1) to ensure accurate representation of the patient's condition.
Documentation should include a detailed description of the ulcer's size, depth, and characteristics, as well as any signs of infection. Clinical assessments, treatment plans, and progress notes are essential to support the use of L89.153.
