ICD-10 Coding for Lice Infestation(B85.0, B85.1, B85.3, B85.4)
Complete ICD-10-CM coding and documentation guide for Lice Infestation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lice Infestation
B85.0-B85.4Primary Range
Pediculosis and Phthiriasis
This range covers all types of lice infestations, including head, body, pubic, and mixed infestations.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B85.0 | Pediculosis due to Pediculus humanus capitis (Head lice) | Use when there is confirmed infestation of head lice. |
|
| B85.1 | Pediculosis due to Pediculus humanus corporis (Body lice) | Use when there is confirmed infestation of body lice. |
|
| B85.3 | Phthiriasis (Pubic lice) | Use when there is confirmed infestation of pubic lice. |
|
| B85.4 | Mixed pediculosis and phthiriasis | Use when there is confirmed infestation of multiple lice types. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for head lice
Essential facts and insights about Lice Infestation
Primary ICD-10-CM Codes for lice
Decision Criteria
clinical Criteria
- Presence of live lice or viable nits on scalp.
documentation Criteria
- Documented visual inspection or microscopy confirmation.
Clinical Validation Requirements
- Live lice or nits on scalp hair
- Pediculus capitis confirmed by microscopy
Code-Specific Risks
- Incorrectly coding for body or pubic lice when only head lice are present.
Coding Notes
- Ensure documentation specifies the type of lice and location of infestation.
B85.1 - Pediculosis due to Pediculus humanus corporis (Body lice)
Use when there is confirmed infestation of body lice.
Applicable To
- Body lice infestation
Excludes
- Head lice (B85.0)
- Pubic lice (B85.3)
Clinical Validation Requirements
- Body lice in clothing seams
- Pruritic rash on trunk
Coding Notes
Ensure documentation specifies the type of lice and location of infestation.
B85.3 - Phthiriasis (Pubic lice)
Use when there is confirmed infestation of pubic lice.
Applicable To
- Pubic lice infestation
Excludes
- Head lice (B85.0)
- Body lice (B85.1)
Clinical Validation Requirements
- Crab lice in pubic region
- Blue maculae on thighs
Coding Notes
Ensure documentation specifies the type of lice and location of infestation.
B85.4 - Mixed pediculosis and phthiriasis
Use when there is confirmed infestation of multiple lice types.
Applicable To
- Mixed lice infestation
Clinical Validation Requirements
- Infestation involving multiple sites (e.g., scalp and pubic area)
Coding Notes
Ensure documentation specifies all affected areas and types of lice.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Excoriation of skin
L98.8Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Pediculosis due to Pediculus humanus corporis (Body lice)
B85.1Phthiriasis (Pubic lice)
B85.3Pediculosis due to Pediculus humanus capitis (Head lice)
B85.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Lice Infestation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B85.0.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to lack of specificity.
Mitigation Strategy
Always specify the type and location of lice., Use diagnostic methods to confirm infestation.
Impact
Reimbursement: May lead to claim denials or incorrect reimbursement., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate health records and data reporting.
Mitigation Strategy
Verify the location of lice and use the correct code for head lice (B85.0).
Impact
Reimbursement: Potential for claim rejections due to insufficient documentation., Compliance: Risk of audit findings for improper coding., Data Quality: Compromised data accuracy for public health tracking.
Mitigation Strategy
Ensure documentation clearly states all affected areas.
Impact
Risk of audits due to incorrect coding of lice type.
Mitigation Strategy
Ensure thorough documentation and confirmation of lice type.
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 Lice Infestation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lice Infestation
Use these documentation templates to ensure complete and accurate documentation for Lice Infestation. These templates include all required elements for proper coding and billing.
Pediatric Head Lice
Specialty: PediatricsRequired Elements
- Location of lice
- Number of live lice and nits
- Diagnostic method
- Treatment history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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