Pressure injury stage (sacral region)
Rule pressure_injury version 2026.11-1 · condition: Pressure injury
Published source
NPIAP Pressure Injury Stages (revised staging system) (2016). Stage 1-4, unstageable, deep tissue pressure injury definitions. https://www.vumc.org/pip/sites/default/files/NPIAP-Staging-Poster.pdf · public page checked 2026-11-14
Stage 3: full-thickness skin loss, fat visible, no fascia/muscle/tendon/bone. Stage 4: full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone. Unstageable: obscured by slough or eschar.
Also: ICD-10-CM Official Guidelines for Coding and Reporting FY2027 (2026). I.B.14: the pressure ulcer stage may be taken from other clinicians (e.g. a wound nurse); the diagnosis itself must be documented by the provider; conflicts are queried. link
Inputs
- wound_stage
- Stage quoted from the wound-care note
- wound_site
- Site quoted from the wound-care note
Thresholds
None (categorical).
Derived values
| Name | Expression |
|---|---|
| sacral | wound_site == 'sacral' |
Outcomes
| Outcome | When | Status | Supports |
|---|---|---|---|
| no_wound_note No staged wound in the wound-care documentation | not present(wound_stage) | insufficient | — |
| other_site Wound site '{wound_site}' is outside the embedded code subset (sacral region only) | wound_site != 'sacral' | judgement | — |
| stage1 Wound nurse documents stage 1, sacral | sacral and wound_stage == '1' | supported | L89.151 Pressure injury of sacral region, stage 1 |
| stage2 Wound nurse documents stage 2, sacral | sacral and wound_stage == '2' | supported | L89.152 Pressure injury of sacral region, stage 2 |
| stage3 Wound nurse documents stage 3, sacral | sacral and wound_stage == '3' | supported | L89.153 Pressure injury of sacral region, stage 3 |
| stage4 Wound nurse documents stage 4, sacral | sacral and wound_stage == '4' | supported | L89.154 Pressure injury of sacral region, stage 4 |
| unstageable Wound nurse documents an unstageable injury, sacral | sacral and wound_stage == 'unstageable' | supported | L89.150 Pressure injury of sacral region, unstageable |
| dti Wound nurse documents deep tissue injury, sacral | sacral and wound_stage == 'deep tissue' | supported | L89.156 Pressure-induced deep tissue damage of sacral region |
ICD-10-CM specificity ladder (FY2026 CC/MCC status as a secondary diagnosis)
- L89.159 Pressure ulcer of sacral region, unspecified stage · non-CC
- L89.151 Pressure ulcer of sacral region, stage 1 · non-CC (refines L89.159)
- L89.152 Pressure ulcer of sacral region, stage 2 · non-CC (refines L89.159)
- L89.153 Pressure ulcer of sacral region, stage 3 · MCC (refines L89.159)
- L89.154 Pressure ulcer of sacral region, stage 4 · MCC (refines L89.159)
- L89.150 Pressure ulcer of sacral region, unstageable · non-CC (refines L89.159)
- L89.156 Pressure-induced deep tissue damage of sacral region · non-CC (refines L89.159)
Query topic: skin integrity documentation · prompts for an undocumented diagnosis: yes
Where clinical judgement is required
- The rule reads the stage only from wound-care documentation; it never stages a wound itself.
- Present-on-admission status is not determined here.