ICDcodes.org
FY2027

L89.604 — Pressure ulcer of unspecified heel, stage 4

BillableUnspecifiedMCC

Is L89.604 billable?

Yes, but L89.604 will trip a Medicare edit. L89.604 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists L89.604 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.

L89.604 at a glance

CodeL89.604
DescriptionPressure ulcer of unspecified heel, stage 4
BillableYes
Code setICD-10-CM FY2027
Valid for encountersOctober 1, 2026 – September 30, 2027

What Medicare edits apply to L89.604?

The Medicare Code Editor screens inpatient claims before they are grouped. These edits name L89.604 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 L89.604 group to?

L89.604 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, L89.604 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 L89.604 listed in the Alphabetic Index?

The Alphabetic Index lists these routes under L89.6, the nearest indexed parent of L89.604. Use them to find the family, then select the specific code.

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

Inclusion terms

Alternative wording in documentation that is classified to L89.604.

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

Code first — inherited from L89

The underlying condition below must be sequenced before L89.604. L89.604 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 L89.604, but a patient may have both at the same time. When documentation supports it, L89.604 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

The conditions below are not part of L89.604, but a patient may have both at the same time. When documentation supports it, L89.604 and the excluded code may both be reported.

How long has L89.604 existed?

L89.604 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.

Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.

What other codes are in the L89.60 family? (6)