ICD-10 L89.304
Billable / Specific HCC v28: 157 MCCPressure ulcer of unspecified buttock, stage 4
About ICD-10-CM L89.304
ICD-10-CM code L89.304 represents Pressure ulcer of unspecified buttock, stage 4. This is a billable/specific code in the Skin and Subcutaneous Tissue chapter (block L89). The 2026 edition of ICD-10-CM L89.304 became effective on October 1, 2025.
Coding Tips for L89.304
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
L89.304 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.
L89.304 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 L89.304. Per CMS ICD-10-CM Tabular 2026.
- Healing pressure ulcer of unspecified buttock, stage 4
- Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon, or bone, unspecified buttock
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 unspecified buttock, 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 L89.304
Local Coverage Determinations (LCDs) from CMS MACs that list L89.304 as a covered diagnosis.
Showing top 10 of 79 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing L89.304.
3 Medicare
1 Aetna
1 NY Medicaid
CPT Codes Commonly Billed with L89.304
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 L89.304 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 |
|---|---|---|
| L89.304 | 70705 | 10111 |
| L89.304 | 70724 | 10112 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To L89.304
Other codes in section L80-L99 (Other disorders of the skin and subcutaneous tissue).
ICD-10 L89.304, Billing FAQ
Is ICD-10 code L89.304 billable? +
Yes, L89.304 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 L89.304? +
ICD-10 L89.304 includes: Healing pressure ulcer of unspecified buttock, stage 4; Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon, or bone, unspecified buttock.
Does L89.304 affect Medicare Advantage HCC risk adjustment? +
Yes. L89.304 maps to CMS-HCC v28 category 157. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is L89.304 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 L89.304 map to? +
Per CMS GEMs, L89.304 maps to ICD-9 codes: 70705, 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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