Question 1

What is ICD-10 code L00?

Accepted Answer

L00 is the ICD-10-CM diagnosis code for staphylococcal scalded skin syndrome. A serious bacterial skin infection caused by Staphylococcus aureus where the skin appears scalded or burned, often affecting infants and young children. L00 sits in the ICD-10-CM chapter for diseases of the skin and subcutaneous tissue (l00-l99), within the section covering infections of the skin and subcutaneous tissue (l00-l08).

L00 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.

This is a severe condition requiring immediate treatment; ensure proper documentation of extent and severity.

Question 2

Is L00 an HCC code?

Accepted Answer

No. L00 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is L00 billable?

Accepted Answer

Yes. L00 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. L00 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for L00?

Accepted Answer

L00 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards L00 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting L00?

Accepted Answer

This is a severe condition requiring immediate treatment; ensure proper documentation of extent and severity Do not confuse with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome, which have different etiologies

L00

Is L00 an HCC code?

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Referenced in blog posts

Open L00 in the Interactive Encoder