L97.406 — Non-pressure chronic ulcer of unspecified heel and midfoot with bone involvement without evidence of necrosis

BillableUnspecifiedCC

Is L97.406 billable?

Yes, but L97.406 will trip a Medicare edit. L97.406 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists L97.406 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

L97.406 at a glance

Code	L97.406
Description	Non-pressure chronic ulcer of unspecified heel and midfoot with bone involvement without evidence of necrosis
Billable	Yes
Code set	ICD-10-CM FY2027
Valid for encounters	October 1, 2026 – September 30, 2027

What Medicare edits apply to L97.406?

The Medicare Code Editor screens inpatient claims before they are grouped. These edits name L97.406 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 L97.406 group to?

L97.406 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, L97.406 is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.

How is L97.406 listed in the Alphabetic Index?

These are the routes through the Alphabetic Index that lead to L97.406. They show the wording a clinician may have documented, which often differs from the Tabular description.

Ulcer, ulcerated, ulcerating, ulceration, ulcerative › lower limb › heel › with › bone involvement without evidence of necrosis
Ulcer, ulcerated, ulcerating, ulceration, ulcerative › lower limb › midfoot › with › bone involvement without evidence of necrosis

Code first — inherited from L97

The underlying condition below must be sequenced before L97.406. L97.406 describes a manifestation and cannot be the principal or first-listed diagnosis.

any associated underlying condition, such as:
any associated gangrene (I96)
atherosclerosis of the lower extremities (I70.23-, I70.24-, I70.33-, I70.34-, I70.43-, I70.44-, I70.53-, I70.54-, I70.63-, I70.64-, I70.73-, I70.74-)
chronic venous hypertension (I87.31-, I87.33-)
diabetic ulcers (E08.621, E08.622, E09.621, E09.622, E10.621, E10.622, E11.621, E11.622, E13.621, E13.622)
postphlebitic syndrome (I87.01-, I87.03-)
postthrombotic syndrome (I87.01-, I87.03-)
varicose ulcer (I83.0-, I83.2-)

Excludes2 — not included here — inherited from Chapter 12

The conditions below are not part of L97.406, but a patient may have both at the same time. When documentation supports it, L97.406 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 L97