Pressure ulcer of contiguous site of back, buttock and hip, stage 1
ICD-10 L89.41 is a billable code used to indicate a diagnosis of pressure ulcer of contiguous site of back, buttock and hip, stage 1.
L89.41 refers to a stage 1 pressure ulcer located on contiguous sites of the back, buttock, and hip. Clinically, a stage 1 pressure ulcer is characterized by non-blanchable erythema of intact skin, indicating localized redness that does not fade when pressure is applied. The affected area may feel warmer or cooler compared to surrounding tissue and may present with a change in texture. The anatomy involved includes the epidermis and dermis, where the pressure ulcer develops due to prolonged pressure, often exacerbated by shear and friction forces. Disease progression can lead to more severe stages of pressure ulcers if not addressed promptly, potentially resulting in deeper tissue damage. Diagnostic considerations include a thorough skin assessment, patient history, and risk factor evaluation, such as immobility, nutritional status, and comorbid conditions. Early identification and intervention are crucial to prevent progression to higher stages of pressure ulcers, which can complicate treatment and increase healthcare costs.
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
L89.41 specifically covers stage 1 pressure ulcers located on the back, buttock, and hip. It is characterized by intact skin with non-blanchable erythema. Conditions such as immobility, malnutrition, and chronic illness can contribute to the development of these ulcers.
L89.41 should be used when documenting a stage 1 pressure ulcer on the specified sites. It is important to differentiate it from other stages (L89.42 for stage 2, L89.43 for stage 3, etc.) based on the clinical presentation and depth of tissue damage.
Documentation for L89.41 should include a detailed skin assessment, noting the location, size, and characteristics of the ulcer. Additionally, the patient's risk factors, such as mobility status and nutritional assessment, should be documented to support the diagnosis.
