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ICD-10 Guide
ICD-10 CodesL97.421

L97.421

Billable

Non-pressure chronic ulcer of left heel and midfoot limited to breakdown of skin

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

Code Description

ICD-10 L97.421 is a billable code used to indicate a diagnosis of non-pressure chronic ulcer of left heel and midfoot limited to breakdown of skin.

Key Diagnostic Point:

L97.421 refers to a non-pressure chronic ulcer of the left heel and midfoot, specifically characterized by a breakdown of the skin without involvement of deeper tissues. Clinically, these ulcers often present as non-healing wounds that may be painful and can lead to secondary infections if not properly managed. The anatomy involved includes the skin and subcutaneous tissue of the heel and midfoot regions, which are susceptible to ulceration due to factors such as poor circulation, diabetes, or prolonged pressure. Disease progression can vary; if left untreated, these ulcers may worsen, leading to deeper tissue involvement or systemic complications. Diagnostic considerations include a thorough patient history, physical examination, and possibly imaging studies to assess the extent of the ulcer and underlying conditions. It is crucial to differentiate these ulcers from pressure ulcers (bedsores) and other types of skin lesions to ensure appropriate treatment and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other ulcer types and underlying conditions.
  • Treatment complexity: May involve multidisciplinary approaches including wound care, infection management, and addressing underlying health issues.
  • Documentation requirements: Detailed documentation of ulcer characteristics, treatment plans, and patient history is essential.
  • Coding specificity: Requires precise coding to capture the specific location and nature of the ulcer.

Audit Risk Factors

  • Common coding errors: Misclassification of the ulcer type or location.
  • Documentation gaps: Incomplete records regarding the ulcer's characteristics or treatment history.
  • Billing challenges: Potential denials due to lack of specificity in documentation or coding.

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: Podiatry

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

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ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of L97.421 lies in its association with chronic wounds, which can lead to increased healthcare utilization and costs. Population health impact includes the need for effective management strategies to prevent complications such as infections or amputations, particularly in high-risk populations like those with diabetes. Quality measures may focus on wound healing rates and patient outcomes, emphasizing the importance of timely and appropriate care for chronic ulcers.

ICD-9 vs ICD-10

The clinical significance of L97.421 lies in its association with chronic wounds, which can lead to increased healthcare utilization and costs. Population health impact includes the need for effective management strategies to prevent complications such as infections or amputations, particularly in high-risk populations like those with diabetes. Quality measures may focus on wound healing rates and patient outcomes, emphasizing the importance of timely and appropriate care for chronic ulcers.

Reimbursement & Billing Impact

Reimbursement considerations include the need for comprehensive treatment plans that may involve wound care management and follow-up visits. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the treatment provided. Best practices include ensuring that all relevant clinical information is captured in the medical record and that coding accurately reflects the patient's condition and treatment.

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 L97.421?

L97.421 covers non-pressure chronic ulcers specifically located on the left heel and midfoot, characterized by skin breakdown without deeper tissue involvement. It is important to document the ulcer's chronicity and any underlying conditions such as diabetes or vascular disease.

When should L97.421 be used instead of related codes?

L97.421 should be used when the ulcer is specifically located on the left heel and midfoot and is not due to pressure. If the ulcer is on the right side or is a pressure ulcer, different codes should be selected.

What documentation supports L97.421?

Documentation should include a detailed description of the ulcer's location, size, depth, and any associated symptoms. Additionally, records of treatment plans, patient history, and any comorbidities should be included to support the diagnosis.