ICD-10 L98.419
Billable / Specific HCC v28: 161Non-pressure chronic ulcer of buttock with unspecified severity
About ICD-10-CM L98.419
ICD-10-CM code L98.419 represents Non-pressure chronic ulcer of buttock with unspecified severity. This is a billable/specific code in the Skin and Subcutaneous Tissue chapter (block L98). The 2026 edition of ICD-10-CM L98.419 became effective on October 1, 2025.
Coding Tips for L98.419
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
L98.419 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 L98.419
Local Coverage Determinations (LCDs) from CMS MACs that list L98.419 as a covered diagnosis.
Showing top 10 of 116 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing L98.419.
1 Cigna
1 Medicare
CPT Codes Commonly Billed with L98.419
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 L98.419 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 |
|---|---|---|
| L98.419 | 7078 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To L98.419
Other codes in section L80-L99 (Other disorders of the skin and subcutaneous tissue).
ICD-10 L98.419, Billing FAQ
Is ICD-10 code L98.419 billable? +
Yes, L98.419 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does L98.419 affect Medicare Advantage HCC risk adjustment? +
Yes. L98.419 maps to CMS-HCC v28 category 161. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does L98.419 map to? +
Per CMS GEMs, L98.419 maps to ICD-9 codes: 7078. 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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