L10.5 ICD-10-CM Code: Drug-induced pemphigus
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)
L10.5
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceDrug-induced pemphigus
Pemphigus-like blistering and skin erosions that develop as a side effect of certain medications, which typically resolve after the drug is discontinued.
Buddy Insight
Drug-induced pemphigus represents a medication-related autoimmune blistering disease that may resolve with drug discontinuation.
CMS-HCC V28
00
RAF 0
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 L10.5 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for L10.5 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for L10.5 in this effective period.
Excludes 1
Official- pemphigus neonatorum (L01.03)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for L10.5 in this effective period.
Use Additional
Official- code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
Code Also
OfficialICD-10-CM does not list Code Also instructions for L10.5 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 L10.5 an HCC code?
No. L10.5 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
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 L10.5
For L10.5to 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 L10.5 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
L10.5 is the ICD-10-CM diagnosis code for drug-induced pemphigus. Pemphigus-like blistering and skin erosions that develop as a side effect of certain medications, which typically resolve after the drug is discontinued. L10.5 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).
L10.5 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.
Only maps to RxHCC 314 (Pemphigus) for prescription drug risk adjustment, reflecting the medication-related nature of this condition. Does not map to V28 HCC categories, indicating different risk profile compared to idiopathic pemphigus. Coders reviewing L10.5 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for L10.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Drug-induced pemphigus represents a medication-related autoimmune blistering disease that may resolve with drug discontinuation. This diagnosis is crucial for medication management and may have different prognosis compared to idiopathic pemphigus.
Documentation Requirements
- ✓Temporal relationship between drug exposure and symptom onset
- ✓Identification of suspected causative medication
- ✓Clinical presentation consistent with pemphigus
- ✓Histopathologic confirmation of acantholysis
- ✓Direct immunofluorescence results
- ✓Documentation of drug discontinuation
- ✓Response to drug withdrawal
- ✓Alternative medication considerations