ICD-10 Code for Pressure Wound on Coccyx
The ICD-10 code for a pressure ulcer on the coccyx requires both a site code (707.05 in ICD-9, or L89.15- in ICD-10) and a stage code to be complete and accurate for billing and documentation purposes.
Primary Coding Structure
The coccyx is the most common anatomical location for pressure ulcers in hospitalized patients, along with the sacrum, heels, and occiput 1, 2. The ICD-10 coding system requires:
- Site designation: L89.15- specifically identifies the coccyx as the anatomical location 3
- Stage specification: The sixth character must indicate the ulcer stage (1-4 or unstageable) 3
Complete ICD-10 Codes for Coccygeal Pressure Ulcers
- L89.150 - Pressure ulcer of sacral region, unstageable 3
- L89.151 - Pressure ulcer of sacral region, stage 1 3
- L89.152 - Pressure ulcer of sacral region, stage 2 3
- L89.153 - Pressure ulcer of sacral region, stage 3 3
- L89.154 - Pressure ulcer of sacral region, stage 4 3
Critical Coding Considerations
Underreporting of stage codes is a documented problem in pressure ulcer documentation. Studies examining Medicare claims data found significant underreporting of pressure ulcer stages when only site codes were recorded without accompanying stage codes 3. This creates:
- Incomplete medical records that fail to capture severity 3
- Potential billing and reimbursement issues under the Hospital-Acquired Condition (HAC) program 3
- Inability to track progression or improvement of the wound 3
Present on Admission (POA) Documentation
Always document whether the pressure ulcer was present on admission or hospital-acquired, as this affects reimbursement under Medicare's HAC-POA program 3. Key points:
- Stage III and IV pressure ulcers that develop during hospitalization are considered preventable HACs and subject to payment adjustment 3
- If a lower-stage ulcer was present on admission and progressed to Stage III or IV during hospitalization, coding guidelines may incorrectly classify it as POA, underreporting true hospital-acquired cases 3
- Use POA indicator "Y" (yes), "N" (no), "U" (unknown), or "W" (clinically undetermined) appropriately 3
Common Pitfalls to Avoid
- Never code only the site without the stage - this represents incomplete documentation that varies by hospital type and location 3
- Do not assume all coccygeal ulcers are the same - the coccyx and sacrum are distinct anatomical sites, though often grouped together in clinical discussions 1, 4
- Recognize that most coccygeal pressure ulcers present at Stage 2, Stage 3, or unstageable (representing 33%, 26%, and 30% respectively in burn populations) 1