ICD-10 Coding for Onychomycosis(B35.1)
Complete ICD-10-CM coding and documentation guide for Onychomycosis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Onychomycosis
B35-B49Primary Range
Mycoses
This range includes fungal infections, with B35.1 specifically for dermatophytic onychomycosis.
Key Information: ICD-10 code for onychomycosis
Essential facts and insights about Onychomycosis
Primary ICD-10-CM Code for onychomycosis
Decision Criteria
clinical Criteria
- Presence of septate hyphae in KOH test
coding Criteria
- Use B35.1 only with confirmed lab results
documentation Criteria
- Document specific organism and test results
Applicable To
- Onychomycosis due to dermatophytes
Excludes
- Onycholysis (L60.1)
Clinical Validation Requirements
- KOH microscopy showing septate hyphae
- Fungal culture identifying dermatophytes
- PCR detecting dermatophyte DNA
Code-Specific Risks
- Incorrectly coding without lab confirmation
- Omitting coexisting conditions like tinea pedis
Coding Notes
- Ensure lab confirmation before using B35.1.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Onycholysis
L60.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Onychomycosis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B35.1.
Impact
Clinical: Potential misdiagnosis and inappropriate treatment., Regulatory: Non-compliance with coding standards., Financial: Denial of claims due to insufficient documentation.
Mitigation Strategy
Always confirm with lab tests., Educate providers on documentation standards.
Impact
Reimbursement: Claims may be denied without proper documentation., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on fungal infection prevalence.
Mitigation Strategy
Ensure lab tests confirm fungal infection before coding.
Impact
Coding B35.1 without lab confirmation is a frequent audit finding.
Mitigation Strategy
Implement mandatory lab test confirmation before coding.
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 Onychomycosis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Onychomycosis
Use these documentation templates to ensure complete and accurate documentation for Onychomycosis. These templates include all required elements for proper coding and billing.
Podiatry Progress Note
Specialty: PodiatryRequired Elements
- Patient history
- Physical examination findings
- Lab test results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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