What is ICD-10 code L88?

L88 is the ICD-10-CM diagnosis code for Pyoderma gangrenosum. A rare, severe skin condition characterized by rapidly developing painful ulcers that can destroy tissue, often associated with inflammatory bowel disease or other systemic conditions. L88 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. L88 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. L88 is a payment HCC under the CMS risk adjustment model. Under the CMS-HCC V28 risk adjustment model it maps to Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders with a community, non-dual, aged base RAF weight of 0.406. It was not retained as a payment HCC under V24. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. HCC Buddy maintains the V28 and V24 mapping, RAF weight, and MEAT documentation criteria for L88 sourced directly from the CMS-HCC model files.

Yes. L88 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. L88 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.

What is the V28 vs V24 difference for L88?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. L88 is a payment HCC under V28 (Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders) but was not retained as a payment HCC under V24. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting L88?

Always investigate and code any associated systemic conditions (such as inflammatory bowel disease) as secondary diagnoses Document the location and extent of ulceration for complete clinical picture Because L88 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

L88: Pyoderma gangrenosum — ICD-10 | Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin

ICD-10-CM Code View

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Code lookupL88Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Other disorders of the skin and subcutaneous tissue (L80-L99)

L88

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

Pyoderma gangrenosum

A rare, severe skin condition characterized by rapidly developing painful ulcers that can destroy tissue, often associated with inflammatory bowel disease or other systemic conditions.

Buddy Insight

Pyoderma gangrenosum is a rare neutrophilic dermatosis characterized by rapidly progressive, painful ulcers with undermined violaceous borders.

CMS-HCC V28

Mapped

HCC 387

Pemphigus, Pemphigoid, and Ot...

RAF 0.406

CMS-HCC V24

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ACA/HHS

Mapped

HCC 217

HHS-HCC 217

Varies by metal level

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

Mapped

HCC 314

Pemphigus

RAF 0.317

Code Book Path

Official

L8Other disorders of the skin and subcutaneous tissue (L80-L99)

L88Pyoderma gangrenosum

Inclusion Terms

Official

Phagedenic pyoderma

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for L88 in this effective period.

Related Child Codes

Official

ICD-10-CM does not list child codes under L88 for this display context.

Includes

Official

ICD-10-CM does not list Includes notes for L88 in this effective period.

Excludes 1

Official

dermatitis gangrenosa (L08.0)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for L88 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for L88 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for L88 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation of pyoderma gangrenosum diagnosis

Clinical description of ulcer characteristics (undermined borders, violaceous rim)

Biopsy results (neutrophilic infiltration, exclusion of infection and malignancy)

Assessment for associated systemic conditions (inflammatory bowel disease, hematologic disorders, arthritis)

MEAT Support

HCC Buddy guidance

Provider documentation of pyoderma gangrenosum diagnosis

Clinical description of ulcer characteristics (undermined borders, violaceous rim)

Biopsy results (neutrophilic infiltration, exclusion of infection and malignancy)

Assessment for associated systemic conditions (inflammatory bowel disease, hematologic disorders, arthritis)

Audit Caution

HCC Buddy guidance

Coding as a generic chronic skin ulcer when pyoderma gangrenosum is specifically diagnosed

Confusing pyoderma (infectious) with pyoderma gangrenosum (autoimmune/neutrophilic) — very different conditions

Failing to code associated underlying conditions (inflammatory bowel disease, hematologic malignancy)

Not recognizing pathergy — surgical consultation for debridement can worsen the condition

Common Mistakes

HCC Buddy guidance

L97.909 (Non-pressure chronic ulcer of unspecified site) — non-specific ulcer; use L88 when pyoderma gangrenosum is diagnosed

L89.x (Pressure ulcer) — different mechanism; pressure ulcers result from sustained pressure on tissue

I83.0 (Varicose veins with ulcer) — venous ulcers have different characteristics and etiology

L08.0 (Pyoderma) — infectious pyoderma is completely different from the autoimmune pyoderma gangrenosum

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 L88 an HCC code?

Yes. L88 maps to Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders under the CMS-HCC V28 risk adjustment model.

HCC Category Mapping

V28HCC 387, Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders

0.406

RxHCCHCC 314, Pemphigus

0.317

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work L88 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for L88

For L88to 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 L88 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

L88 is the ICD-10-CM diagnosis code for pyoderma gangrenosum. A rare, severe skin condition characterized by rapidly developing painful ulcers that can destroy tissue, often associated with inflammatory bowel disease or other systemic conditions. L88 sits in the ICD-10-CM chapter for diseases of the skin and subcutaneous tissue (l00-l99), within the section covering other disorders of the skin and subcutaneous tissue (l80-l99).

Under the CMS-HCC V28 risk adjustment model, L88 maps to Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders (HCC 387) with a community, non-dual, aged base RAF weight of 0.406. L88 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.

Always investigate and code any associated systemic conditions (such as inflammatory bowel disease) as secondary diagnoses. Because L88 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 L88 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Always investigate and code any associated systemic conditions (such as inflammatory bowel disease) as secondary diagnoses
•Document the location and extent of ulceration for complete clinical picture

Clinical Significance

Pyoderma gangrenosum is a rare neutrophilic dermatosis characterized by rapidly progressive, painful ulcers with undermined violaceous borders. It is clinically significant because it is frequently associated with systemic diseases (inflammatory bowel disease, rheumatoid arthritis, hematologic malignancies) and exhibits pathergy, where trauma or surgery worsens the condition. Misdiagnosis leading to surgical debridement can be devastating.

Documentation Requirements

✓Provider documentation of pyoderma gangrenosum diagnosis
✓Clinical description of ulcer characteristics (undermined borders, violaceous rim)
✓Biopsy results (neutrophilic infiltration, exclusion of infection and malignancy)
✓Assessment for associated systemic conditions (inflammatory bowel disease, hematologic disorders, arthritis)
✓Current treatment plan (immunosuppression, wound care)
✓Documentation of pathergy phenomenon if present
✓Evidence the condition was actively managed during the encounter

Excludes 1, Do NOT code together

dermatitis gangrenosa (L08.0)

Commonly Confused Codes

•L97.909 (Non-pressure chronic ulcer of unspecified site): non-specific ulcer; use L88 when pyoderma gangrenosum is diagnosed
•L89.x (Pressure ulcer): different mechanism; pressure ulcers result from sustained pressure on tissue
•I83.0 (Varicose veins with ulcer): venous ulcers have different characteristics and etiology
•L08.0 (Pyoderma): infectious pyoderma is completely different from the autoimmune pyoderma gangrenosum

Code Hierarchy

└L88Pyoderma gangrenosum

L88 ICD-10-CM Code: Pyoderma gangrenosum

HCC Buddy Code Card

L88

Is L88 an HCC code?

HCC Category Mapping

MEAT Criteria for L88

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Clinical Significance

Documentation Requirements

Excludes 1, Do NOT code together

Commonly Confused Codes

Code Hierarchy

Work L88 in HCC Buddy