L89.004 — Pressure ulcer of unspecified elbow, stage 4

BillableUnspecifiedMCC

Is L89.004 billable?

Yes, but L89.004 will trip a Medicare edit. L89.004 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists L89.004 under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.

More specific alternatives

L89.004 at a glance

Code	L89.004
Description	Pressure ulcer of unspecified elbow, stage 4
Billable	Yes
Code set	ICD-10-CM FY2027
Valid for encounters	October 1, 2026 – September 30, 2027

What Medicare edits apply to L89.004?

The Medicare Code Editor screens inpatient claims before they are grouped. These edits name L89.004 directly.

Unspecified — a laterality-specific code exists — MCE edit 20

A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.

Which MS-DRGs does L89.004 group to?

L89.004 sits in MDC 09 and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.

573Skin Graft for Skin Ulcer or Cellulitis with MCCsurgical
574Skin Graft for Skin Ulcer or Cellulitis with CCsurgical
575Skin Graft for Skin Ulcer or Cellulitis without CC/MCCsurgical

As a secondary diagnosis, L89.004 is a major complication or comorbidity (MCC), which can move a stay into a higher-paying DRG. It also carries Hospital-Acquired Condition category 04.

How is L89.004 listed in the Alphabetic Index?

The Alphabetic Index lists these routes under L89.0, the nearest indexed parent of L89.004. Use them to find the family, then select the specific code.

Ulcer, ulcerated, ulcerating, ulceration, ulcerative › pressure › elbow
Ulcer, ulcerated, ulcerating, ulceration, ulcerative › pressure › stage 1 › elbow
Ulcer, ulcerated, ulcerating, ulceration, ulcerative › pressure › stage 2 › elbow
Ulcer, ulcerated, ulcerating, ulceration, ulcerative › pressure › stage 3 › elbow
Ulcer, ulcerated, ulcerating, ulceration, ulcerative › pressure › stage 4 › elbow
Ulcer, ulcerated, ulcerating, ulceration, ulcerative › pressure › unspecified stage › elbow
Ulcer, ulcerated, ulcerating, ulceration, ulcerative › pressure › unstageable › elbow

Inclusion terms

Alternative wording in documentation that is classified to L89.004.

Healing pressure ulcer of unspecified elbow, stage 4
Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon, or bone, unspecified elbow

Code first — inherited from L89

The underlying condition below must be sequenced before L89.004. L89.004 describes a manifestation and cannot be the principal or first-listed diagnosis.

any associated gangrene (I96)

Excludes2 — not included here — inherited from Chapter 12

The conditions below are not part of L89.004, but a patient may have both at the same time. When documentation supports it, L89.004 and the excluded code may both be reported.

certain conditions originating in the perinatal period (P04-P96)
certain infectious and parasitic diseases (A00-B99)
complications of pregnancy, childbirth and the puerperium (O00-O9A)
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
endocrine, nutritional and metabolic diseases (E00-E88)
lipomelanotic reticulosis (I89.8)
neoplasms (C00-D49)
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
systemic connective tissue disorders (M30-M36)
viral warts (B07.-)

Excludes2 — not included here — inherited from L89