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L49.4 ICD-10-CM Code: Exfoliation due to erythematous condition involving 40-49 percent of body surface

Compare with another code for L49.4Check this code on a claim

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
2 Excludes1 · 6 code-first instructions

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too, and is marked with where it comes from.

Code firstfrom L49Sequence the underlying condition before this code
  • erythematous condition causing exfoliation, such as:
  • Ritter's disease (L00)
  • (Staphylococcal) scalded skin syndrome (L00)
  • Stevens-Johnson syndrome (L51.1)

+2 more in Instructions

Excludes1from L49-L54Not reported with this code unless documented as unrelated

Where it sits Source: CMS/NCHS

Under:Chapter 12: Diseases of the Skin and Subcutaneous TissueL49-L54 Urticaria and erythemaL49 Exfoliation due to erythematous conditions according to extent of body surface involved

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 606 — MINOR SKIN DISORDERS WITH MCC (MDC 09)
  • MS-DRG 607 — MINOR SKIN DISORDERS WITHOUT MCC (MDC 09)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for L49.4 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on L49.4 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from L49-L54

Code First

Underlying conditions that must be sequenced before this code.

  • erythematous condition causing exfoliation, such as:
  • Ritter's disease (L00)
  • (Staphylococcal) scalded skin syndrome (L00)
  • Stevens-Johnson syndrome (L51.1)
  • Stevens-Johnson syndrome-toxic epidermal necrolysis overlap syndrome (L51.3)
  • Toxic epidermal necrolysis (L51.2)

Source: inherited from L49

Coder workflow for L49.4

MedCoder structured workflow — derived from this code’s own official record

Before you code L49.4

  1. L49.4’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with L49.4. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in L49.4’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewA69.2, L71

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then L49.4.
    No → Continue; do not add an underlying condition the record does not document.

    ReviewL00, L51.1, L51.3, L51.2

Consider L49.4. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
The underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).

Official instructions as workflow

  • Excludes1 — check before selecting L49.4(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with L49.4: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareA69.2, L71

    See the official tabular notes · Guidelines I.A.12.a

  • Code First — sequencing check(6 notes)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before L49.4. Do not add an underlying condition the record does not document.

    ReviewL00, L51.1, L51.3, L51.2

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition L49.4 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewA69.2, L71

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is L49.4 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Documentation: The underlying condition the Code First note names is documented alongside this condition.

Coding question: How are the two sequenced?

Path: Review the Code First note.

Reason: The underlying condition is sequenced first and the manifestation follows (Guidelines I.A.13).

ReviewL00, L51.1, L51.3, L51.2

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse L49.4 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of L49.4 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • A69.2— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of Lyme disease moves the case to A69.2; the two are not reported together unless documented as unrelated.

    Full comparison: L49.4 vs A69.2 →

  • L71— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of rosacea moves the case to L71; the two are not reported together unless documented as unrelated.

    Full comparison: L49.4 vs L71 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Exfoliation due to erythematous condition involving 40-49 percent of body surface is a billable ICD-10-CM diagnosis code (L49.4).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Verify Before Coding

  • Principal-diagnosis restriction. The Medicare Code Editor lists this code as unacceptable as a principal diagnosis: it describes a circumstance influencing health status rather than a current illness or injury being treated. It is valid as a secondary diagnosis.
  • CC as a secondary diagnosis (FY2027). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name L49.4 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Use Additional Code instructions: L00 — Staphylococcal scalded skin syndrome (via L49.-), L51 — Erythema multiforme (via L49.-).

These codes instruct coders to additionally report this code when it applies.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier.

Named in the grouper logic of 2 MS-DRGs: DRG 606 (MDC 09), DRG 607 (MDC 09).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):SKN002 — Other specified inflammatory condition of skin (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Principal diagnosis restriction (Medicare Code Editor)

Not acceptable as a principal diagnosis on an inpatient claim.

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Other specified inflammatory condition of skin).

L44.2 — Lichen striatus, L44.3 — Lichen ruber moniliformis, L44.4 — Infantile papular acrodermatitis [Gianotti-Crosti], L44.8 — Other specified papulosquamous disorders, L44.9 — Papulosquamous disorder, unspecified, L45 — Papulosquamous disorders in diseases classified elsewhere, L49.0 — Exfoliation due to erythematous condition involving less than 10 percent of body surface, L49.1 — Exfoliation due to erythematous condition involving 10-19 percent of body surface, L49.2 — Exfoliation due to erythematous condition involving 20-29 percent of body surface, L49.3 — Exfoliation due to erythematous condition involving 30-39 percent of body surface, L49.5 — Exfoliation due to erythematous condition involving 50-59 percent of body surface, L49.6 — Exfoliation due to erythematous condition involving 60-69 percent of body surface, L49.7 — Exfoliation due to erythematous condition involving 70-79 percent of body surface, L49.8 — Exfoliation due to erythematous condition involving 80-89 percent of body surface, L49.9 — Exfoliation due to erythematous condition involving 90 or more percent of body surface, L50.0 — Allergic urticaria, L50.1 — Idiopathic urticaria, L50.2 — Urticaria due to cold and heat, L50.3 — Dermatographic urticaria, L50.4 — Vibratory urticaria, +145 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Exfoliation”; these codes share that main term but sit in a different category of the Tabular List.

K08.0 — Exfoliation of teeth due to systemic causes

Contextual Map

Every relationship of L49.4 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run L49.4 with these 2 related codes in Claim Check

Hierarchy

Referenced by Use Additional Code instructions

  • L00 — Staphylococcal scalded skin syndrome[Use Additional Code](via L49.-): “code to identify percentage of skin exfoliation (L49.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027
  • L51 — Erythema multiforme[Use Additional Code](via L49.-): “code to identify percentage of skin exfoliation (L49.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027

Clinical classification (CCSR)

MS-DRG Grouper

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2027
  • DRG 606 — MINOR SKIN DISORDERS WITH MCC[MS-DRG]: “MINOR SKIN DISORDERS WITH MCC (MDC 09)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027
  • DRG 607 — MINOR SKIN DISORDERS WITHOUT MCC[MS-DRG]: “MINOR SKIN DISORDERS WITHOUT MCC (MDC 09)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027

MDC crossing

  • MDC 09 — Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast[MDC crossing]: “Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 7,378 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Exfoliation, due to erythematous conditions according to extent of body surface involved, 40-49 percent of body surface[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes (10)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "L49.4 — Exfoliation due to erythematous condition involving 40-49 percent of body surface." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/l49.4-exfoliation-due-to-erythematous-condition-involving-40-49-percent-of-body-surface

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Exfoliation due to erythematous condition involving 40-49 percent of body surface

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to L49.4 in its code family, with their registry titles.

View all codes in the L49 family