Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 05.00.60g


Attachment:A

Policy #:05.00.60g

Description:ICD-10 Codes

Title:Pressure-Reducing Support Surfaces


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



This is not an all-inclusive list:

L89.003 Pressure ulcer of unspecified elbow, stage 3
L89.004 Pressure ulcer of unspecified elbow, stage 4
L89.013 Pressure ulcer of right elbow, stage 3

L89.014 Pressure ulcer of right elbow, stage 4
L89.023 Pressure ulcer of left elbow, stage 3
L89.024 Pressure ulcer of left elbow, stage 4
L89.100 Pressure ulcer of unspecified part of back, unstageable
L89.101 Pressure ulcer of unspecified part of back, stage 1
L89.102 Pressure ulcer of unspecified part of back, stage 2
L89.103 Pressure ulcer of unspecified part of back, stage 3
L89.104 Pressure ulcer of unspecified part of back, stage 4
L89.109 Pressure ulcer of unspecified part of back, unspecified stage
L89.110 Pressure ulcer of right upper back, unstageable
L89.111 Pressure ulcer of right upper back, stage 1
L89.112 Pressure ulcer of right upper back, stage 2
L89.113 Pressure ulcer of right upper back, stage 3
L89.114 Pressure ulcer of right upper back, stage 4
L89.119 Pressure ulcer of right upper back, unspecified stage
L89.120 Pressure ulcer of left upper back, unstageable
L89.121 Pressure ulcer of left upper back, stage 1
L89.122 Pressure ulcer of left upper back, stage 2
L89.123 Pressure ulcer of left upper back, stage 3
L89.124 Pressure ulcer of left upper back, stage 4
L89.129 Pressure ulcer of left upper back, unspecified stage
L89.130 Pressure ulcer of right lower back, unstageable
L89.131 Pressure ulcer of right lower back, stage 1
L89.132 Pressure ulcer of right lower back, stage 2
L89.133 Pressure ulcer of right lower back, stage 3
L89.134 Pressure ulcer of right lower back, stage 4
L89.139 Pressure ulcer of right lower back, unspecified stage
L89.140 Pressure ulcer of left lower back, unstageable
L89.141 Pressure ulcer of left lower back, stage 1
L89.142 Pressure ulcer of left lower back, stage 2
L89.143 Pressure ulcer of left lower back, stage 3
L89.144 Pressure ulcer of left lower back, stage 4
L89.149 Pressure ulcer of left lower back, unspecified stage
L89.150 Pressure ulcer of sacral region, unstageable
L89.151 Pressure ulcer of sacral region, stage 1
L89.152 Pressure ulcer of sacral region, stage 2
L89.153 Pressure ulcer of sacral region, stage 3
L89.154 Pressure ulcer of sacral region, stage 4
L89.159 Pressure ulcer of sacral region, unspecified stage
L89.200 Pressure ulcer of unspecified hip, unstageable
L89.201 Pressure ulcer of unspecified hip, stage 1

L89.202 Pressure ulcer of unspecified hip, stage 2
L89.203 Pressure ulcer of unspecified hip, stage 3

L89.204 Pressure ulcer of unspecified hip, stage 4
L89.209 Pressure ulcer of unspecified hip, unspecified stage

L89.210 Pressure ulcer of right hip, unstageable
L89.211 Pressure ulcer of right hip, stage 1
L89.212 Pressure ulcer of right hip, stage 2
L89.213 Pressure ulcer of right hip, stage 3
L89.214 Pressure ulcer of right hip, stage 4
L89.219 Pressure ulcer of right hip, unspecified stage
L89.220 Pressure ulcer of left hip, unstageable
L89.221 Pressure ulcer of left hip, stage 1
L89.222 Pressure ulcer of left hip, stage 2
L89.223 Pressure ulcer of left hip, stage 3
L89.224 Pressure ulcer of left hip, stage 4
L89.229 Pressure ulcer of left hip, unspecified stage
L89.300 Pressure ulcer of unspecified buttock, unstageable
L89.301 Pressure ulcer of unspecified buttock, stage 1
L89.302 Pressure ulcer of unspecified buttock, stage 2
L89.303 Pressure ulcer of unspecified buttock, stage 3

L89.304 Pressure ulcer of unspecified buttock, stage 4
L89.309 Pressure ulcer of unspecified buttock, unspecified stage

L89.310 Pressure ulcer of right buttock, unstageable
L89.311 Pressure ulcer of right buttock, stage 1
L89.312 Pressure ulcer of right buttock, stage 2
L89.313 Pressure ulcer of right buttock, stage 3
L89.314 Pressure ulcer of right buttock, stage 4
L89.319 Pressure ulcer of right buttock, unspecified stage
L89.320 Pressure ulcer of left buttock, unstageable
L89.321 Pressure ulcer of left buttock, stage 1
L89.322 Pressure ulcer of left buttock, stage 2
L89.323 Pressure ulcer of left buttock, stage 3
L89.324 Pressure ulcer of left buttock, stage 4
L89.329 Pressure ulcer of left buttock, unspecified stage
L89.40 Pressure ulcer of contiguous site of back, buttock and hip, unspecified stage
L89.41 Pressure ulcer of contiguous site of back, buttock and hip, stage 1
L89.42 Pressure ulcer of contiguous site of back, buttock and hip, stage 2
L89.43 Pressure ulcer of contiguous site of back, buttock and hip, stage 3
L89.44 Pressure ulcer of contiguous site of back, buttock and hip, stage 4
L89.45 Pressure ulcer of contiguous site of back, buttock and hip, unstageable
L89.503 Pressure ulcer of unspecified ankle, stage 3
L89.504 Pressure ulcer of unspecified ankle, stage 4
L89.513 Pressure ulcer of right ankle, stage 3
L89.514 Pressure ulcer of right ankle, stage 4
L89.523 Pressure ulcer of left ankle, stage 3
L89.524 Pressure ulcer of left ankle, stage 4
L89.603 Pressure ulcer of unspecified heel, stage 3
L89.604 Pressure ulcer of unspecified heel, stage 4
L89.613 Pressure ulcer of right heel, stage 3
L89.614 Pressure ulcer of right heel, stage 4
L89.623 Pressure ulcer of left heel, stage 3
L89.624 Pressure ulcer of left heel, stage 4
L89.813 Pressure ulcer of head, stage 3
L89.814 Pressure ulcer of head, stage 4
L89.893 Pressure ulcer of other site, stage 3
L89.894 Pressure ulcer of other site, stage 4
L89.93 Pressure ulcer of unspecified site, stage 3
L89.94 Pressure ulcer of unspecified site, stage 4



Version Effective Date: 11/26/2018
Version Issued Date: 11/26/2018
Version Reissued Date: N/A

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