Providers should review their protocols to prepare for the changes.

The 2020 updates to ICD-10-CM contain some significant changes to Chapter 12, Diseases of the Skin and Subcutaneous Tissue. These changes include the addition of new codes for the reporting of pressure-induced deep-tissue damage, also known as deep-tissue pressure injury (DTPI), and a new chapter-specific guideline that provides direction on how these codes are assigned.

What is Pressure-Induced Deep-Tissue Damage?
Pressure-induced deep-tissue damage is a serious form of pressure ulcer caused by direct pressure to the skin and soft tissue that causes ischemia. The injury is characterized by purple or maroon areas of intact skin. These injuries can also present as blood blisters. Because they form in deep tissue, these ulcers may not be visible until they are far advanced, and they may be harder to recognize in patients with darker skin tone. Associated symptoms include pain at the site of compromised tissue, and differences in tissue consistency or temperature when compared to adjacent tissue.

The Codes
The codes for pressure-induced deep-tissue injury are found in the L89, Pressure Ulcer code category. Codes in this category have a fifth or sixth character that identifies the pressure ulcer’s stage. Previously, coding guideline I.C.12.a.2 directed that these injuries also be reported with a fifth or sixth character representing an unstageable pressure ulcer. The updates introduce a new fifth or sixth character of “6” to specifically classify instances of pressure-induced deep-tissue injury.

Example: L89.016 Deep tissue pressure injury of right elbow

The Guidelines
ICD-10-CM 2020 contains a new guideline directing how codes for deep-tissue pressure injury are to be assigned, as outlined below:

I.C.12.a.7 Pressure-Induced Deep-Tissue Damage

“For pressure-induced deep-tissue damage or deep-tissue pressure injury, assign only the appropriate code for pressure-induced deep-tissue damage (L89.- -6).”

The direction in the new guideline means that it is inappropriate to assign codes that report unstageable pressure ulcers, or pressure ulcers classified as stage 1-4, for a diagnosis of pressure-induced deep-tissue damage or deep-tissue pressure injury.

Guideline I.C.12.a.2 has also been edited to remove the guidance directing a code for unstageable pressure ulcer for documentation of deep-tissue pressure injury.

Codes for deep-tissue pressure injury are classified alongside the other codes in the L89 category. This means that all guidelines pertaining to the coding of pressure ulcers apply to these codes as well.

What Does This Mean for My Organization?
Because documentation sometimes lacks specificity, coders should be educated about the clinical indicators that suggest the presence of deep-tissue pressure injury to allow them to recognize when a query for this condition is appropriate.

Clinical indicators on which to educate coders include:

  • Etiology
  • Risk Factors
  • Diagnostic Studies
  • Treatment

The introduction of new codes signals the need for organizations to review the code choices available in their electronic health records. Options for these new codes should be added to the appropriate dropdown menus or pick lists in order for each facility to capture its rate of occurrence for statistical and quality reporting purposes.

The addition of these codes to the electronic health record (EHR) should be brought to the attention of physicians and CDI specialists so they don’t continue to assign the now-inappropriate codes for unstageable pressure ulcers, simply out of routine or habit.


  • ICD-10-CM codes for pressure ulcers (L89) use a fifth or sixth character of “6” to report pressure-induced deep-tissue damage or deep-tissue pressure injury
  • Codes for unstageable pressure ulcers or for ulcers stages 1-4 should not be assigned for diagnoses of pressure-induced deep-tissue damage or deep-tissue pressure injury
  • The other guidelines directing the assignment of codes for pressure ulcers also apply to these codes
  • Educate coders on the clinical indicators that suggest deep-tissue pressure injury
  • Include these codes in the options available in your organization’s electronic health record to enable tracking for statistical and quality purposes
  • Alert physicians and CDI specialists to the presence of the new codes; awareness will help them “see” and implement the use of these codes

Visit the link below for a short overview of the pertinence of and a summary of the new codes, as provided by the National Pressure Ulcer Advisory Panel.

Programming Note:

Listen to Cari Greenwood during today’s live edition of Talk Ten Tuesday, 10-10:30 a.m. EST.


Cari Greenwood, RHIA, CCS, CPC, CICA

Cari is an independent consultant with more than 18 years of experience in coding and revenue cycle management. Her experience includes inpatient and facility/professional fee outpatient coding and auditing. She also applies her coding and auditing expertise to instruction and training, client support and curriculum development. Cari earned a post-baccalaureate certificate in health information management from Weber State University.

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