ICD-10 Coding for Pressure Ulcer Sacrum(L89.150, L89.151, L89.152, L89.153, L89.154, L89.156)
Complete ICD-10-CM coding and documentation guide for Pressure Ulcer Sacrum. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pressure Ulcer Sacrum
L89.150-L89.156Primary Range
Pressure ulcer of sacrum, stages 1-4, unstageable, and deep tissue injury
This range covers all stages of pressure ulcers specific to the sacrum, including unstageable and deep tissue injuries.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| L89.150 | Unstageable pressure ulcer of sacrum | Use when the depth of the ulcer cannot be determined due to eschar or slough. |
|
| L89.151 | Stage 1 pressure ulcer of sacrum | Use for non-blanchable erythema of intact skin over the sacrum. |
|
| L89.152 | Stage 2 pressure ulcer of sacrum | Use for partial thickness skin loss with exposed dermis. |
|
| L89.153 | Stage 3 pressure ulcer of sacrum | Use for full thickness skin loss with visible adipose tissue. |
|
| L89.154 | Stage 4 pressure ulcer of sacrum | Use for full thickness skin and tissue loss with exposed bone, tendon, or muscle. |
|
| L89.156 | Deep tissue injury of sacrum | Use for deep tissue injury with discolored intact skin. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for stage 3 sacral pressure ulcer
Essential facts and insights about Pressure Ulcer Sacrum
Primary ICD-10-CM Codes for pressure ulcer sacrum
Decision Criteria
clinical Criteria
- Presence of eschar or slough covering the wound bed
Applicable To
- Pressure ulcer with eschar obscuring the wound bed
Excludes
- Pressure ulcer with gangrene (I96)
Clinical Validation Requirements
- Eschar or slough covering the wound bed
Code-Specific Risks
- Confusion with unspecified stage
Coding Notes
- Ensure documentation specifies unstageable due to eschar or slough.
L89.151 - Stage 1 pressure ulcer of sacrum
Use for non-blanchable erythema of intact skin over the sacrum.
Applicable To
- Non-blanchable erythema of intact skin
Clinical Validation Requirements
- Non-blanchable redness of intact skin
Coding Notes
Ensure documentation specifies non-blanchable erythema.
L89.152 - Stage 2 pressure ulcer of sacrum
Use for partial thickness skin loss with exposed dermis.
Applicable To
- Partial thickness skin loss with exposed dermis
Clinical Validation Requirements
- Partial thickness loss of skin with exposed dermis
Coding Notes
Document the presence of partial thickness skin loss.
L89.153 - Stage 3 pressure ulcer of sacrum
Use for full thickness skin loss with visible adipose tissue.
Applicable To
- Full thickness skin loss with visible adipose tissue
Clinical Validation Requirements
- Full thickness skin loss with visible adipose tissue
Coding Notes
Ensure documentation specifies full thickness skin loss.
L89.154 - Stage 4 pressure ulcer of sacrum
Use for full thickness skin and tissue loss with exposed bone, tendon, or muscle.
Applicable To
- Full thickness skin and tissue loss with exposed bone, tendon, or muscle
Clinical Validation Requirements
- Exposed bone, tendon, or muscle
Coding Notes
Document the exposure of bone, tendon, or muscle.
L89.156 - Deep tissue injury of sacrum
Use for deep tissue injury with discolored intact skin.
Applicable To
- Purple or maroon localized area of discolored intact skin
Clinical Validation Requirements
- Purple or maroon localized area of discolored intact skin
Coding Notes
Ensure documentation specifies deep tissue injury characteristics.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Gangrene
I96Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Unspecified stage pressure ulcer of sacrum
L89.159Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Pressure Ulcer Sacrum to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code L89.150.
Impact
Clinical: May lead to misunderstanding of the condition severity., Regulatory: Non-compliance with standardized terminology., Financial: Potential claim denials due to vague documentation.
Mitigation Strategy
Use 'pressure ulcer' in all documentation, Educate staff on correct terminology
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Ensure documentation specifies if the ulcer is unstageable due to eschar or slough.
Impact
Reimbursement: Potential loss of reimbursement for the care provided., Compliance: Failure to comply with coding guidelines., Data Quality: Misrepresentation of patient condition.
Mitigation Strategy
Always code the stage present at admission, even if healed by discharge.
Impact
Incorrect staging can lead to audit findings and financial penalties.
Mitigation Strategy
Regular training on pressure ulcer staging and documentation.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Pressure Ulcer Sacrum, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pressure Ulcer Sacrum
Use these documentation templates to ensure complete and accurate documentation for Pressure Ulcer Sacrum. These templates include all required elements for proper coding and billing.
Documenting a stage 3 sacral pressure ulcer
Specialty: Wound CareRequired Elements
- Location: Sacrum
- Stage: 3
- Measurements: Size and depth
- Wound bed description
- Exudate type and amount
- Periwound condition
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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