ICD-10 L89.124
Billable / Specific HCC v28: 157 MCCPressure ulcer of left upper back, stage 4
About ICD-10-CM L89.124
ICD-10-CM code L89.124 represents Pressure ulcer of left upper back, stage 4. This is a billable/specific code in the Skin and Subcutaneous Tissue chapter (block L89). The 2026 edition of ICD-10-CM L89.124 became effective on October 1, 2025.
Coding Tips for L89.124
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
L89.124 is a CMS-HCC v28 risk-adjustment code (category 157). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
L89.124 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under L89.124. Per CMS ICD-10-CM Tabular 2026.
- Healing pressure ulcer of left upper back, stage 4
- Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon, or bone, left upper back
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, MCC
1126:479 codes Pressure ulcer of left upper back, stage 4. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for L89.124
Local Coverage Determinations (LCDs) from CMS MACs that list L89.124 as a covered diagnosis.
Showing top 10 of 390 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing L89.124.
1 Cigna
5 Medicare
1 Aetna
CPT Codes Commonly Billed with L89.124
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert L89.124 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| L89.124 | 70702 | 10111 |
| L89.124 | 70724 | 10112 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To L89.124
Other codes in section L80-L99 (Other disorders of the skin and subcutaneous tissue).
ICD-10 L89.124, Billing FAQ
Is ICD-10 code L89.124 billable? +
Yes, L89.124 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to L89.124? +
ICD-10 L89.124 includes: Healing pressure ulcer of left upper back, stage 4; Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon, or bone, left upper back.
Does L89.124 affect Medicare Advantage HCC risk adjustment? +
Yes. L89.124 maps to CMS-HCC v28 category 157. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is L89.124 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does L89.124 map to? +
Per CMS GEMs, L89.124 maps to ICD-9 codes: 70702, 70724. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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