L04.3 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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Code lookupL04.3

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Infections of the skin and subcutaneous tissue (L00-L08)

L04.3

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Acute lymphadenitis of lower limb

A sudden infection of the lymph nodes in the leg or foot, causing swelling and inflammation.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

L04Acute lymphadenitis L04.3Acute lymphadenitis of lower limb

Inclusion Terms

Official

Acute lymphadenitis of hip

Excludes 2

Official

acute lymphadenitis of groin (L04.1)
certain conditions originating in the perinatal period (P04-P96)Inherited from L00-L99, L00-L08
certain infectious and parasitic diseases (A00-B99)Inherited from L00-L99, L00-L08
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from L00-L99, L00-L08
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from L00-L99, L00-L08
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from L00-L99, L00-L08
lipomelanotic reticulosis (I89.8)Inherited from L00-L99, L00-L08
neoplasms (C00-D49)Inherited from L00-L99, L00-L08
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from L00-L99, L00-L08
systemic connective tissue disorders (M30-M36)Inherited from L00-L99, L00-L08
viral warts (B07.-)Inherited from L00-L99, L00-L08
hordeolum (H00.0)Inherited from L00-L99, L00-L08
infective dermatitis (L30.3)Inherited from L00-L99, L00-L08
local infections of skin classified in Chapter 1Inherited from L00-L99, L00-L08
lupus panniculitis (L93.2)Inherited from L00-L99, L00-L08
panniculitis NOS (M79.3)Inherited from L00-L99, L00-L08
panniculitis of neck and back (M54.0-)Inherited from L00-L99, L00-L08
Perlèche NOS (K13.0)Inherited from L00-L99, L00-L08
Perlèche due to candidiasis (B37.0)Inherited from L00-L99, L00-L08
Perlèche due to riboflavin deficiency (E53.0)Inherited from L00-L99, L00-L08
pyogenic granuloma (L98.0)Inherited from L00-L99, L00-L08
relapsing panniculitis [Weber-Christian] (M35.6)Inherited from L00-L99, L00-L08
zoster (B02.-)Inherited from L00-L99, L00-L08

Related Codes

Official

L04.0Acute lymphadenitis of face, head and neck L04.1Acute lymphadenitis of trunk L04.2Acute lymphadenitis of upper limb L04.8Acute lymphadenitis of other sites L04.9Acute lymphadenitis, unspecified

Includes

Official

abscess (acute) of lymph nodes, except mesentericInherited from L04
acute lymphadenitis, except mesentericInherited from L04

Excludes 1

Official

chronic or subacute lymphadenitis, except mesenteric (I88.1)Inherited from L04
enlarged lymph nodes (R59.-)Inherited from L04
human immunodeficiency virus [HIV] disease resulting in generalized lymphadenopathy (B20)Inherited from L04
lymphadenitis NOS (I88.9)Inherited from L04
nonspecific mesenteric lymphadenitis (I88.0)Inherited from L04

Code First

Official

No Code First sequencing instructions are included in this display for L04.3. Check the code and parent instructions in the Code Book.

Use Additional

Official

code (B95-B97) to identify infectious agent.Inherited from L00-L08

Code Also

Official

No Code Also instructions are included in this display for L04.3. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Specify which leg (right or left) if documentation indicates laterality

Distinguish from chronic lymphadenitis (L04.1) which has a slower onset

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is L04.3 an HCC code?

No. L04.3 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: L04.3
Description: Acute lymphadenitis of lower limb
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

L04.3 is the ICD-10-CM diagnosis code for acute lymphadenitis of lower limb. A sudden infection of the lymph nodes in the leg or foot, causing swelling and inflammation. L04.3 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).

L04.3 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Specify which leg (right or left) if documentation indicates laterality.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for L04.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.