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ICD-10 Guide
ICD-10 CodesL89.6

L89.6

Non-billable

Pressure ulcer of heel

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

Code Description

ICD-10 L89.6 is a used to indicate a diagnosis of pressure ulcer of heel.

Key Diagnostic Point:

L89.6 refers to a pressure ulcer of the heel, a localized injury to the skin and/or underlying tissue, typically over a bony prominence, resulting from prolonged pressure, shear, or friction. The heel is particularly susceptible due to its anatomical structure, which includes a thin layer of skin overlying the calcaneus bone. Clinically, pressure ulcers can present as non-blanchable erythema, open wounds, or necrotic tissue, depending on the severity. The progression of a pressure ulcer can be categorized into stages, from Stage I (intact skin with non-blanchable redness) to Stage IV (full-thickness tissue loss with exposed bone, tendon, or muscle). Diagnostic considerations include assessing the ulcer's stage, size, and presence of infection, as well as evaluating the patient's overall health status, mobility, and nutritional needs. Early identification and intervention are crucial to prevent complications such as infection or sepsis, which can significantly impact patient outcomes.

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 and location.
  • Documentation gaps may arise from insufficient detail on ulcer assessment and treatment.
  • Billing challenges often involve denials related to lack of medical necessity or inadequate documentation.

Specialty Focus

Medical Specialties

Wound Care

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

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

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 those classified under L89.6, 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 or those with chronic illnesses. Effective management of pressure ulcers is crucial for improving patient outcomes, reducing hospital stays, and minimizing healthcare utilization. Epidemiologically, the incidence of pressure ulcers is a key quality measure in healthcare settings, influencing care protocols and resource allocation.

ICD-9 vs ICD-10

Pressure ulcers, including those classified under L89.6, 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 or those with chronic illnesses. Effective management of pressure ulcers is crucial for improving patient outcomes, reducing hospital stays, and minimizing healthcare utilization. Epidemiologically, the incidence of pressure ulcers is a key quality measure in healthcare settings, influencing care protocols and resource allocation.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the ulcer, the complexity of care provided, and adherence to payer-specific guidelines. Common denials may arise from insufficient documentation or failure to meet the criteria for medical necessity. Coders should ensure that all relevant clinical information is included in the patient's medical record to support the claim and 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 L89.6?

L89.6 specifically covers pressure ulcers located on the heel, which may include various stages of ulceration, from Stage I (non-blanchable erythema) to Stage IV (full-thickness tissue loss). It does not cover ulcers located on other body parts, which are classified under different codes.

When should L89.6 be used instead of related codes?

L89.6 should be used when documenting a pressure ulcer specifically located on the heel. It is important to differentiate it from other pressure ulcer codes based on the anatomical site and stage of the ulcer.

What documentation supports L89.6?

Documentation for L89.6 should include a detailed description of the ulcer's location, stage, size, and any associated symptoms. Additionally, treatment plans, patient assessments, and progress notes should be included to support the diagnosis.