Question 1

What is ICD-10 code L03.116?

Accepted Answer

L03.116 is the ICD-10-CM diagnosis code for cellulitis of left lower limb. A bacterial skin infection (cellulitis) affecting the left leg or lower limb, causing redness, swelling, warmth, and pain. L03.116 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).

L03.116 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.

Lower limb cellulitis is common and may be associated with venous insufficiency or lymphedema; document any predisposing factors.

Question 2

Is L03.116 an HCC code?

Accepted Answer

No. L03.116 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 L03.116 billable?

Accepted Answer

Yes. L03.116 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. L03.116 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 L03.116?

Accepted Answer

L03.116 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 L03.116 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 L03.116?

Accepted Answer

Lower limb cellulitis is common and may be associated with venous insufficiency or lymphedema; document any predisposing factors Specify the anatomical location within the lower limb if documented (thigh, calf, ankle) for clinical clarity

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L03.116

Is L03.116 an HCC code?

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L03.116 ICD-10-CM Code: Cellulitis of left lower limb

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L03.116

Is L03.116 an HCC code?

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