ICD-10 Coding for Keloid(L91.0)
Complete ICD-10-CM coding and documentation guide for Keloid. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Keloid
L91-L99Primary Range
Other disorders of skin and subcutaneous tissue
This range includes conditions related to hypertrophic scars and keloids, with L91.0 being the specific code for keloids.
Other disorders of skin and subcutaneous tissue
This broader range includes various skin disorders, with L91.0 specifically addressing keloids.
Key Information: ICD-10 code for keloid
Essential facts and insights about Keloid
Primary ICD-10-CM Code for keloid
Decision Criteria
clinical Criteria
- Presence of a keloid with symptoms such as pain or functional impairment.
coding Criteria
- Differentiate from acne-related keloids and non-hypertrophic scars.
documentation Criteria
- Document location, size, and symptoms to support medical necessity.
Clinical Validation Requirements
- Presence of thick, glassy collagen bundles extending beyond original wound margins
- Symptoms such as pain, pruritus, or functional impairment
Code-Specific Risks
- Misclassification with L90.5 for non-hypertrophic scars
- Incorrectly coding acne-related keloids under L91.0
Coding Notes
- Ensure documentation specifies symptoms and functional impact to justify medical necessity.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Keloid to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code L91.0.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to lack of medical necessity.
Mitigation Strategy
Ensure all symptoms are documented in the patient's record., Use templates to guide comprehensive documentation.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data and statistics.
Mitigation Strategy
Query provider to confirm if the scar is a typical scar or a keloid.
Impact
Reimbursement: Potential underpayment for procedures., Compliance: Non-compliance with procedural coding standards., Data Quality: Misrepresentation of the complexity of care provided.
Mitigation Strategy
Use complex repair codes like 13101 instead of simple excision codes.
Impact
Lack of detailed symptom documentation may trigger audits.
Mitigation Strategy
Ensure comprehensive documentation of symptoms and functional impacts.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Keloid, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Keloid
Use these documentation templates to ensure complete and accurate documentation for Keloid. These templates include all required elements for proper coding and billing.
Keloid treatment with intralesional injection
Specialty: DermatologyRequired Elements
- Indication for treatment
- Location and size of keloid
- Symptoms and functional impact
- Treatment details including medication and dosage
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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