ICD-10-CM Code: L89.220 - Pressure ulcer of left hip, unstageable
This code is assigned to pressure ulcers on the left hip, but the severity cannot be clinically determined. The stage of pressure ulcers are described as follows:
Stage 1: Non-blanchable erythema of intact skin. The skin is red but returns to its normal color after pressure is released. This stage indicates the beginning of tissue damage, and if left untreated can progress to more severe stages.
Stage 2: Partial-thickness skin loss with the involvement of epidermis and dermis. The wound presents as an abrasion, blister, or shallow crater. This stage involves deeper tissue damage and requires medical attention.
Stage 3: Full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The wound presents as a deep crater, with visible subcutaneous fat. This stage indicates significant damage to the tissues, often requiring advanced wound care and treatment.
Stage 4: Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendons, joint capsules). The wound may present as a deep crater with exposed bone or tendon, and often requires complex surgical management and prolonged healing.
Unstageable: Full-thickness skin loss in which the base of the ulcer is obscured by slough (yellow, tan, gray, or brown) or eschar (tan, brown, or black). It is not possible to determine the stage of the pressure ulcer unless slough and eschar are removed.
When a patient presents with a pressure ulcer that cannot be staged due to the presence of slough or eschar, the code L89.220, "Pressure ulcer of left hip, unstageable," is assigned.
Exclusions
This code excludes: Decubitus (trophic) ulcer of cervix (uteri) (N86) Diabetic ulcers (E08.621, E08.622, E09.621, E09.622, E10.621, E10.622, E11.621, E11.622, E13.621, E13.622) Non-pressure chronic ulcer of skin (L97.-) Skin infections (L00-L08) Varicose ulcer (I83.0, I83.2)
Code first any associated gangrene (I96).
Dependencies
L89.220 may be linked to several other codes that detail the specific treatment or procedures performed:
CPT Codes: 15950 - Excision, trochanteric pressure ulcer, with primary suture 15951 - Excision, trochanteric pressure ulcer, with primary suture; with ostectomy 15952 - Excision, trochanteric pressure ulcer, with skin flap closure 15953 - Excision, trochanteric pressure ulcer, with skin flap closure; with ostectomy 15956 - Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure 15958 - Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomy 15999 - Unlisted procedure, excision pressure ulcer 97597 - Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less 97598 - Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 97602 - Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session 97605 - Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeter 97606 - Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters 97607 - Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters 97608 - Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters
HCPCS Codes: A2001 - Innovamatrix ac, per square centimeter A2002 - Mirragen advanced wound matrix, per square centimeter A2004 - Xcellistem, 1 mg A2005 - Microlyte matrix, per square centimeter A2006 - Novosorb synpath dermal matrix, per square centimeter A2007 - Restrata, per square centimeter A2008 - Theragenesis, per square centimeter A2009 - Symphony, per square centimeter A2010 - Apis, per square centimeter A2011 - Supra sdrm, per square centimeter A2012 - Suprathel, per square centimeter A2013 - Innovamatrix fs, per square centimeter A2014 - Omeza collagen matrix, per 100 mg A2015 - Phoenix wound matrix, per square centimeter A2016 - Permeaderm b, per square centimeter A2017 - Permeaderm glove, each A2018 - Permeaderm c, per square centimeter A2019 - Kerecis omega3 marigen shield, per square centimeter A2020 - Ac5 advanced wound system (ac5) A2021 - Neomatrix, per square centimeter A2022 - Innovaburn or innovamatrix xl, per square centimeter A2023 - Innovamatrix pd, 1 mg A2024 - Resolve matrix, per square centimeter A2025 - Miro3d, per cubic centimeter A2026 - Restrata minimatrix, 5 mg A4100 - Skin substitute, fda cleared as a device, not otherwise specified A4575 - Topical hyperbaric oxygen chamber, disposable A4640 - Replacement pad for use with medically necessary alternating pressure pad owned by patient A6010 - Collagen based wound filler, dry form, sterile, per gram of collagen A6011 - Collagen based wound filler, gel/paste, per gram of collagen A6021 - Collagen dressing, sterile, size 16 sq. in. or less, each Q4102 - Oasis wound matrix, per square centimeter Q4104 - Integra bilayer matrix wound dressing (BMWD), per square centimeter Q4105 - Integra dermal regeneration template (DRT) or integra omnigraft dermal regeneration matrix, per square centimeter Q4108 - Integra matrix, per square centimeter Q4110 - PriMatrix, per square centimeter Q4114 - Integra flowable wound matrix, injectable, 1cc Q4118 - MatriStem micromatrix, 1 mg Q4121 - TheraSkin, per square centimeter Q4122 - Dermacell, dermacell awm or dermacell awm porous, per square centimeter Q4123 - AlloSkin RT, per square centimeter Q4124 - OASIS ultra tri-layer wound matrix, per square centimeter Q4127 - Talymed, per square centimeter Q4130 - Strattice TM, per square centimeter Q4132 - "Grafix CORE and GrafixPL CORE, per square centimeter Q4133 - Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter Q4135 - Mediskin, per square centimeter Q4136 - E-Z Derm, per square centimeter Q4138 - BioDFence dryflex, per square centimeter Q4140 - Biodfence, per square centimeter Q4141 - AlloSkin AC, per square centimeter Q4143 - Repriza, per square centimeter Q4145 - EpiFix, injectable, 1 mg Q4147 - Architect, Architect PX, or Architect FX, extracellular matrix, per square centimeter Q4151 - AmnioBand or Guardian, per square centimeter Q4155 - NeoxFlo or clarixFlo, 1 mg Q4159 - Affinity, per square centimeter Q4160 - NuShield, per square centimeter Q4164 - Helicoll, per square centimeter Q4165 - Keramatrix or kerasorb, per square centimeter Q4166 - Cytal, per square centimeter Q4167 - Truskin, per square centimeter Q4168 - Amnioband, 1 mg Q4169 - Artacent wound, per square centimeter Q4170 - Cygnus, per square centimeter Q4171 - Interfyl, 1 mg Q4173 - Palingen or palingen xplus, per square centimeter Q4174 - Palingen or promatrx, 0.36 mg per 0.25 cc Q4175 - Miroderm, per square centimeter Q4177 - Floweramnioflo, 0.1 cc Q4178 - Floweramniopatch, per square centimeter Q4179 - Flowerderm, per square centimeter Q4180 - Revita, per square centimeter Q4181 - Amnio wound, per square centimeter Q4182 - Transcyte, per square centimeter Q4183 - Surgigraft, per square centimeter Q4184 - Cellesta or cellesta duo, per square centimeter Q4185 - Cellesta flowable amnion (25 mg per cc); per 0.5 cc Q4186 - Epifix, per square centimeter Q4187 - Epicord, per square centimeter Q4188 - Amnioarmor, per square centimeter Q4189 - Artacent ac, 1 mg Q4190 - Artacent ac, per square centimeter Q4193 - Coll-e-derm, per square centimeter Q4194 - Novachor, per square centimeter Q4195 - Puraply, per square centimeter Q4196 - Puraply am, per square centimeter Q4197 - Puraply xt, per square centimeter Q4198 - Genesis amniotic membrane, per square centimeter Q4199 - Cygnus matrix, per square centimeter Q4200 - Skin te, per square centimeter Q4201 - Matrion, per square centimeter Q4202 - Keroxx (2.5g/cc), 1cc Q4203 - Derma-gide, per square centimeter Q4204 - Xwrap, per square centimeter Q4205 - Membrane graft or membrane wrap, per square centimeter Q4206 - Fluid flow or fluid GF, 1 cc Q4208 - Novafix, per square cenitmeter Q4209 - Surgraft, per square centimeter Q4210 - Axolotl graft or axolotl dualgraft, per square centimeter Q4211 - Amnion bio or Axobiomembrane, per square centimeter Q4212 - Allogen, per cc Q4213 - Ascent, 0.5 mg Q4214 - Cellesta cord, per square centimeter Q4215 - Axolotl ambient or axolotl cryo, 0.1 mg Q4216 - Artacent cord, per square centimeter Q4217 - Woundfix, BioWound, Woundfix Plus, BioWound Plus, Woundfix Xplus or BioWound Xplus, per square centimeter Q4218 - Surgicord, per square centimeter Q4219 - Surgigraft-dual, per square centimeter Q4220 - BellaCell HD or Surederm, per square centimeter Q4221 - Amniowrap2, per square centimeter Q4222 - Progenamatrix, per square centimeter Q4224 - Human health factor 10 amniotic patch (hhf10-p), per square centimeter Q4226 - MyOwn skin, includes harvesting and preparation procedures, per square centimeter Q4227 - Amniocore, per square centimeter Q4229 - Cogenex amniotic membrane, per square centimeter Q4230 - Cogenex flowable amnion, per 0.5 cc Q4231 - Corplex p, per cc Q4232 - Corplex, per square centimeter Q4233 - Surfactor or nudyn, per 0.5 cc Q4234 - Xcellerate, per square centimeter Q4235 - Amniorepair or altiply, per square centimeter Q4236 - Carepatch, per square centimeter Q4237 - Cryo-cord, per square centimeter Q4238 - Derm-maxx, per square centimeter Q4239 - Amnio-maxx or amnio-maxx lite, per square centimeter Q4245 - Amniotext, per cc Q4246 - Coretext or protext, per cc Q4247 - Amniotext patch, per square centimeter Q4248 - Dermacyte amniotic membrane allograft, per square centimeter Q4249 - Amniply, for topical use only, per square centimeter Q4250 - Amnioamp-mp, per square centimeter Q4254 - Novafix dl, per square centimeter Q4255 - Reguard, for topical use only, per square centimeter Q4256 - Mlg-complete, per square centimeter Q4257 - Relese, per square centimeter Q4258 - Enverse, per square centimeter Q4259 - Celera dual layer or celera dual membrane, per square centimeter Q4260 - Signature apatch, per square centimeter Q4261 - Tag, per square centimeter Q4263 - Surgraft tl, per square centimeter Q4265 - Neostim tl, per square centimeter Q4266 - Neostim membrane, per square centimeter Q4267 - Neostim dl, per square centimeter Q4268 - Surgraft ft, per square centimeter Q4269 - Surgraft xt, per square centimeter Q4280 - Xcell amnio matrix, per square centimeter Q4281 - Barrera sl or barrera dl, per square centimeter Q4282 - Cygnus dual, per square centimeter Q4283 - Biovance tri-layer or biovance 3l, per square centimeter Q4284 - Dermabind sl, per square centimeter Q4285 - Nudyn dl or nudyn dl mesh, per square centimeter Q4286 - Nudyn sl or nudyn slw, per square centimeter Q4296 - Rebound matrix, per square centimeter Q4305 - American amnion ac tri-layer, per square centimeter Q4306 - American amnion ac, per square centimeter Q4307 - American amnion, per square centimeter Q4308 - Sanopellis, per square centimeter Q4309 - Via matrix, per square centimeter Q4310 - Procenta, per 100 mg
DRG Codes: 573 - SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC 574 - SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC 575 - SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC 576 - SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC 577 - SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC 578 - SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC 592 - SKIN ULCERS WITH MCC 593 - SKIN ULCERS WITH CC 594 - SKIN ULCERS WITHOUT CC/MCC
Showcases
Usecase 1: A patient is admitted to the hospital with a stage 4 pressure ulcer on the left hip, with a large amount of eschar present. Due to the eschar covering the ulcer base, it cannot be accurately staged. In this scenario, the code L89.220 would be used in conjunction with an appropriate DRG code to report the admission.
Usecase 2: A patient in a long-term care facility develops a pressure ulcer on the left hip, and it is not possible to determine its stage without removing the slough covering the base of the ulcer. This would be coded as L89.220 and potentially additional codes associated with wound management, such as debridement procedures.
Usecase 3: A patient presents at a wound care clinic for evaluation of a pressure ulcer on the left hip. The provider assesses the ulcer, and based on the examination, the provider cannot accurately determine its stage due to the presence of slough. The physician would use L89.220 to document the patient's encounter. The appropriate CPT codes for the provider's services would also be reported.
Importance
Accurate coding is essential in capturing the severity and complexity of pressure ulcers, especially when their stage cannot be definitively determined. The use of the code L89.220 helps track patient care, identify patients requiring specific care pathways, and inform decisions regarding appropriate wound management interventions.
For medical coders, selecting the correct ICD-10-CM codes is crucial. Always consult the latest official coding manuals and guidance from official medical coding organizations to ensure accurate code assignment. Incorrect code selection can lead to financial penalties, audit issues, and even legal repercussions. It is imperative that medical coders understand the legal implications of assigning inaccurate ICD-10-CM codes and utilize reliable resources to ensure accuracy.