ICD-10 Coding for Pilonidal Abscess(L05.01, L05.02)
Complete ICD-10-CM coding and documentation guide for Pilonidal Abscess. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pilonidal Abscess
L05.0-L05.9Primary Range
Pilonidal cyst and sinus
This range includes codes for pilonidal cysts and sinuses, both with and without abscesses.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| L05.01 | Pilonidal cyst with abscess | Use when a pilonidal cyst is documented with an abscess. |
|
| L05.02 | Pilonidal sinus with abscess | Use when a pilonidal sinus or fistula is documented with an abscess. |
|
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 pilonidal abscess
Essential facts and insights about Pilonidal Abscess
Primary ICD-10-CM Codes for pilonidal abscess
Decision Criteria
clinical Criteria
- Documented presence of a cyst with purulent drainage
Applicable To
- Pilonidal cyst with purulent drainage
- Fluctuant mass at sacrococcygeal region
Excludes
- Congenital sacral dimple (Q82.6)
Clinical Validation Requirements
- Presence of a cyst with purulent drainage
- Fluctuant mass in the sacrococcygeal region
Code-Specific Risks
- Confusing cyst with sinus
- Not documenting abscess presence
Coding Notes
- Ensure documentation specifies 'cyst' and 'abscess' to avoid denials.
L05.02 - Pilonidal sinus with abscess
Use when a pilonidal sinus or fistula is documented with an abscess.
Applicable To
- Sinus tract extending laterally
- Coccygeal fistula with abscess
Excludes
- Anal fistula (K60.5)
Clinical Validation Requirements
- Documentation of sinus tracts or fistula with abscess
- Multiple secondary openings
Coding Notes
Ensure documentation specifies 'sinus' and 'abscess' to avoid denials.
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 Pilonidal Abscess to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code L05.01.
Impact
Clinical: Leads to incorrect treatment plans., Regulatory: May result in audit issues., Financial: Can affect reimbursement rates.
Mitigation Strategy
Ensure clinical notes explicitly mention 'abscess'., Use checklists to verify documentation completeness.
Impact
Reimbursement: Incorrect coding can lead to lower reimbursement rates., Compliance: May result in compliance issues during audits., Data Quality: Impacts the accuracy of patient records.
Mitigation Strategy
Clarify with the provider whether the condition is a cyst or sinus.
Impact
Inaccurate documentation of cyst vs. sinus can lead to coding errors.
Mitigation Strategy
Implement regular training sessions for providers on documentation standards.
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 Pilonidal Abscess, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pilonidal Abscess
Use these documentation templates to ensure complete and accurate documentation for Pilonidal Abscess. These templates include all required elements for proper coding and billing.
Excision of pilonidal sinus with abscess
Specialty: SurgeryRequired Elements
- Pre-op and post-op diagnosis
- Procedure details
- Findings and closure method
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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