ICD-10 L97.509
Billable / Specific HCC v28: 161Non-pressure chronic ulcer of other part of unspecified foot with unspecified severity
About ICD-10-CM L97.509
ICD-10-CM code L97.509 represents Non-pressure chronic ulcer of other part of unspecified foot with unspecified severity. This is a billable/specific code in the Skin and Subcutaneous Tissue chapter (block L97). The 2026 edition of ICD-10-CM L97.509 became effective on October 1, 2025.
Coding Tips for L97.509
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
L97.509 is a CMS-HCC v28 risk-adjustment code (category 161). 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.
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.
Medicare LCD Coverage for L97.509
Local Coverage Determinations (LCDs) from CMS MACs that list L97.509 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing L97.509.
1 Cigna
CPT Codes Commonly Billed with L97.509
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 11042 Debridement subcutaneous — pressure ulcers all stages, diabetic ulcer, venous ulcer, wound dehiscence General Surgery
Convert L97.509 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 |
|---|---|---|
| L97.509 | 70715 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To L97.509
Other codes in section L80-L99 (Other disorders of the skin and subcutaneous tissue).
ICD-10 L97.509, Billing FAQ
Is ICD-10 code L97.509 billable? +
Yes, L97.509 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does L97.509 affect Medicare Advantage HCC risk adjustment? +
Yes. L97.509 maps to CMS-HCC v28 category 161. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with L97.509? +
Procedures frequently paired with L97.509 include: 11042.
What ICD-9 codes does L97.509 map to? +
Per CMS GEMs, L97.509 maps to ICD-9 codes: 70715. 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 July 17, 2026.
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