L12.9: Pemphigoid, unspecified

Risk adjustment

L12.9 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 387 Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders0.406 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

L12.9 is named in 9 Medicare coverage policies: 9 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A54641Billing and Coding: Intravenous Immune Globulin (IVIg)-NCD 250.3
• A54643Billing and Coding: Intravenous Immune Globulin (IVIg)-NCD 250.3
• A55639Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions
• A56718Billing and Coding: Intravenous Immunoglobulin (IVIG)