L10.0 ICD-10-CM Code: Pemphigus vulgaris
L10.0 maps to CMS-HCC V28 387. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Bullous disorders (L10-L14)
L10.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePemphigus vulgaris
An autoimmune blistering disease where the body's immune system attacks skin cells, causing painful blisters and erosions primarily in the mouth and on the skin.
Buddy Insight
Pemphigus vulgaris is a severe autoimmune blistering disease with high morbidity and mortality if untreated, requiring intensive immunosuppressive therapy.
CMS-HCC V28
MappedHCC 387
Coefficient HCC 387: 0.406 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 219
Code-level coefficient reference
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 314
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for L10.0. Check the code and parent instructions in the Code Book.
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from L00-L99
- certain infectious and parasitic diseases (A00-B99)Inherited from L00-L99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from L00-L99
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from L00-L99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from L00-L99
- lipomelanotic reticulosis (I89.8)Inherited from L00-L99
- neoplasms (C00-D49)Inherited from L00-L99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from L00-L99
- systemic connective tissue disorders (M30-M36)Inherited from L00-L99
- viral warts (B07.-)Inherited from L00-L99
Related Codes
Includes
OfficialNo Includes notes are included in this display for L10.0. Check the code and parent instructions in the Code Book.
Excludes 1
Official- benign familial pemphigus [Hailey-Hailey] (Q82.8)Inherited from L10-L14, L10
- staphylococcal scalded skin syndrome (L00)Inherited from L10-L14, L10
- toxic epidermal necrolysis [Lyell] (L51.2)Inherited from L10-L14, L10
- pemphigus neonatorum (L01.03)Inherited from L10-L14, L10
Code First
OfficialNo Code First sequencing instructions are included in this display for L10.0. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for L10.0. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for L10.0. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 L10.0 an HCC code?
Yes. L10.0 (Pemphigus vulgaris) maps to HCC 387, Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.406. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: L10.0 is billable and maps to V28 HCC 387, Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- L10.0
- Description
- Pemphigus vulgaris
- HCC (V28)
- HCC 387 — Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders
- RAF reference coefficient
- 0.406
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work L10.0 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for L10.0
For L10.0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
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What This Code Means
L10.0 is the ICD-10-CM diagnosis code for pemphigus vulgaris. An autoimmune blistering disease where the body's immune system attacks skin cells, causing painful blisters and erosions primarily in the mouth and on the skin. L10.0 sits in the ICD-10-CM chapter for diseases of the skin and subcutaneous tissue (l00-l99), within the section covering bullous disorders (l10-l14).
Under the CMS-HCC V28 risk adjustment model, L10.0 maps to Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders (HCC 387) with a source-labeled community, non-dual, aged reference coefficient of 0.406. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Document whether the condition is in remission or active to support medical necessity. For L10.0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for L10.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether the condition is in remission or active to support medical necessity
- •Link to any associated malignancy codes if paraneoplastic pemphigus is suspected
Clinical Significance
Pemphigus vulgaris is a severe autoimmune blistering disease with high morbidity and mortality if untreated, requiring intensive immunosuppressive therapy. This diagnosis indicates a life-threatening condition that significantly impacts patient prognosis and requires specialized dermatological care.
Documentation Requirements
- ✓Clinical presentation with mucosal and cutaneous blisters
- ✓Positive Nikolsky sign documentation
- ✓Histopathologic findings showing acantholysis
- ✓Direct immunofluorescence results showing intercellular IgG deposits
- ✓Indirect immunofluorescence or ELISA results for desmoglein antibodies
- ✓Assessment of disease severity and extent
- ✓Treatment plan including immunosuppressive therapy
- ✓Monitoring for treatment complications