ED Coding and Reimbursement Alert

Question: A patient reports to the emergency department (ED) with a pressure ulcer on their right elbow. Encounter notes indicate that the ulcer featured “necrosis of soft tissue through to bone.” What ICD-10-CM code should I choose for this encounter? I see a lot of different options for pressure ulcer types in the code book.

Arkansas Subscriber

Answer: For this patient, you’ll report L89.014 (Pressure ulcer of right elbow, stage 4). When the physician notes soft-tissue necrosis through to the bone, it’s a stage 4 pressure ulcer.

As you mentioned, however, this is one of several types of pressure ulcer that ICD-10-CM affords codes. Gena Cornett, CPC, CPB, CPCO, CRCR, RCMS, CPB-I, went into detail on pressure ulcer types during her HEALTHCON Regional 2025 presentation “From Wounds to Wins: Expert Tips for Accurate Coding.” Here’s a look at the different types of pressure ulcers, along with some additional information from ICD-10-CM and Cornett:

• Stage 1: Skin changes limited to persistent focal edema, no open wound
• Stage 2: Partial thickness skin loss limited to dermis and epidermis
• Stage 3: Full-thickness skin loss involving damage and necrosis of subcutaneous tissue
• Stage 4: Necrosis of soft tissues through muscle, tendon, or bone
• Unstageable: Stage cannot be determined, i.e., the ulcer is covered in eschar
• Deep tissue injury: No open wound, but the tissues beneath the skin have been damaged.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC