L10.1 ICD-10-CM Code: Pemphigus vegetans
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Bullous disorders (L10-L14)
L10.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePemphigus vegetans
A variant of pemphigus where blisters form in a warty or vegetating pattern, typically in skin folds and areas of friction.
Buddy Insight
Pemphigus vegetans is a rare variant of pemphigus with hyperkeratotic lesions in intertriginous areas, requiring specialized immunosuppressive treatment.
CMS-HCC V28
MappedHCC 387
RAF 0.262
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
MappedHCC 314
RAF 0.0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for L10.1 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for L10.1 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for L10.1 in this effective period.
Excludes 1
Official- pemphigus neonatorum (L01.03)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for L10.1 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for L10.1 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for L10.1 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 L10.1 an HCC code?
Yes. L10.1 maps to Pemphigus and Other Autoimmune Skin Conditions under the CMS-HCC V28 risk adjustment model.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for L10.1
For L10.1to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed L10.1 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
L10.1 is the ICD-10-CM diagnosis code for pemphigus vegetans. A variant of pemphigus where blisters form in a warty or vegetating pattern, typically in skin folds and areas of friction. L10.1 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, L10.1 maps to Pemphigus and Other Autoimmune Skin Conditions (HCC 387) with a community, non-dual, aged base RAF weight of 0.262. L10.1 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Distinguish from pemphigus vulgaris by documenting the vegetating or warty appearance of lesions. Because L10.1 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for L10.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Distinguish from pemphigus vulgaris by documenting the vegetating or warty appearance of lesions
- •Note the location of lesions (intertriginous areas) to support this specific diagnosis
Clinical Significance
Pemphigus vegetans is a rare variant of pemphigus with hyperkeratotic lesions in intertriginous areas, requiring specialized immunosuppressive treatment. This diagnosis represents a chronic autoimmune condition with significant impact on patient quality of life and treatment complexity.
Documentation Requirements
- ✓Clinical presentation with vegetating lesions in skin folds
- ✓Histopathologic evidence of acantholysis and hyperkeratosis
- ✓Direct immunofluorescence showing intercellular IgG deposits
- ✓Desmoglein antibody testing results
- ✓Documentation of characteristic distribution pattern
- ✓Assessment of disease activity and extent
- ✓Immunosuppressive treatment plan
- ✓Response to therapy monitoring