2027 ICD-10-CM Diagnosis Code L12.31Epidermolysis bullosa due to drug
ICD-10-CM Codes›L00–L99›L10-L14›L12
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Not Chronic
L12.31 is a billable ICD-10-CM diagnosis code for epidermolysis bullosa due to drug. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 595 through 596. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 35 closely related codes. Coders also document this condition as acquired epidermolysis bullosa. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified inflammatory condition of skin.
L12.31 no longer risk-adjusts for Medicare Advantage: it mapped to HCC 162 under the retired CMS-HCC V24 model through payment year 2025 but maps to no category in the live V28 model. It still risk-adjusts in the PACE (CMS-HCC V22) category 162, ESRD (V21) category 162, and ESRD (V24) category 162 for payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
L12.31 no longer risk-adjusts for Medicare Advantage: it maps to no payment category in the live CMS-HCC V28 model, although it still risk-adjusts in the other CMS models shown below.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Acquired epidermolysis bullosa
- Autoimmune bullous dermatosis due to drug
- Bullous dermatosis precipitated by drug treatment
- Drug-induced epidermolysis bullosa acquisita
- Epidermal fragility
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to L12.31: its own notes plus those printed at L12.3, L12, block L10-L14, and Chapter 12. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- epidermolysis bullosa (congenital) (Q81.-)
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- lipomelanotic reticulosis (I89.8)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
- systemic connective tissue disorders (M30-M36)
- viral warts (B07.-)
Use Additional Code
Add a second code, after this one, to fully describe the condition.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Epidermolysis Bullosa Acquisita
form of epidermolysis bullosa characterized by trauma-induced, subepidermal blistering with no family history of the disease. direct immunofluorescence shows immunoglobulin g deposited at the dermo-epidermal junction.
Patient EducationClinical
Skin Conditions
Your skin is your body's largest organ. It covers the entire outside of your body. There are many ways that your skin protects your body and helps keep you healthy. For example, it:
The full article covers:
- What does your skin do?
- What problems and conditions can affect your skin?
- How can I keep my skin healthy?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert L12.31 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About L12.31Overview
What is the ICD-10 code for epidermolysis bullosa due to drug?
The ICD-10-CM code for epidermolysis bullosa due to drug is L12.31 (sometimes written as L1231). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is L12.31 (Acquired epidermolysis bullosa) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report epidermolysis bullosa due to drug on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does L12.31 group to?
When epidermolysis bullosa due to drug is the principal diagnosis on an inpatient stay, it groups to MS-DRG 596, 595, with relative weights from 1.1067 to 2.0230 depending on complications. Higher weights mean higher Medicare reimbursement.
Is L12.31 a CC or MCC?
CMS lists L12.31 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 35 closely related codes in its exclusion list.
Can L12.31 be reported with a code from Q81?
Not as a rule. The Excludes1 note at L12.3, which applies to L12.31, lists "epidermolysis bullosa (congenital) (Q81.-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
Does L12.31 risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage. L12.31 mapped to HCC 162 in the retired CMS-HCC V24 model, which last determined payment in 2025, but it maps to no category in the live V28 model; see all codes that no longer risk-adjust. It still risk-adjusts in the PACE (CMS-HCC V22) category 162 (Severe Skin Burn or Condition), ESRD (V21) category 162 (Severe Skin Burn or Condition), and ESRD (V24) category 162 (Severe Skin Burn or Condition).
