B85.4 ICD-10-CM Code: Mixed pediculosis and phthiriasis
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FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Pediculosis, acariasis and other infestations (B85-B89)
B85.4
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMixed pediculosis and phthiriasis
A simultaneous infestation with both lice (pediculosis) and pubic lice (phthiriasis) occurring in the same patient.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Infestation classifiable to more than one of the categories B85.0-B85.3
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for B85.4 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for B85.4 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for B85.4 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for B85.4 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for B85.4 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for B85.4 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is B85.4 an HCC code?
No. B85.4 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
B85.4 is the ICD-10-CM diagnosis code for mixed pediculosis and phthiriasis. A simultaneous infestation with both lice (pediculosis) and pubic lice (phthiriasis) occurring in the same patient. B85.4 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering pediculosis, acariasis and other infestations (b85-b89).
B85.4 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Use this code only when documentation confirms the presence of multiple louse types.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for B85.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when documentation confirms the presence of multiple louse types
- •Ensure treatment plan addresses all infestation types present