ICD-10 Coding for Pilonidal Cyst with Abscess(L05.01, L05.02)
Complete ICD-10-CM coding and documentation guide for Pilonidal Cyst with Abscess. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pilonidal Cyst with Abscess
L05.0-L05.9Primary Range
Pilonidal cyst and sinus
This range covers all pilonidal cysts and sinuses, including those with 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 confirmed with an abscess present. |
|
| L05.02 | Pilonidal sinus with abscess | Use when a pilonidal sinus is confirmed with an abscess present. |
|
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 cyst with abscess
Essential facts and insights about Pilonidal Cyst with Abscess
Primary ICD-10-CM Codes for pilonidal cyst with abscess
Decision Criteria
clinical Criteria
- Presence of purulent drainage and fluctuant mass in natal cleft
Applicable To
- Parasacral dimple with abscess
Excludes
- L02.3 - Cutaneous abscess of buttock
Clinical Validation Requirements
- Presence of a fluctuant mass in the natal cleft
- Purulent drainage observed
- Imaging confirming abscess
Code-Specific Risks
- Incorrectly coding as L05.0 without specifying abscess
Coding Notes
- Ensure documentation specifies 'with abscess' to avoid denials.
L05.02 - Pilonidal sinus with abscess
Use when a pilonidal sinus is confirmed with an abscess present.
Applicable To
- Coccygeal fistula with abscess
Excludes
- L02.3 - Cutaneous abscess of buttock
Clinical Validation Requirements
- Recurrent draining sinus tract with abscess formation
Coding Notes
Ensure documentation specifies 'with abscess' to avoid denials.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Staphylococcus aureus as the cause of diseases classified elsewhere
B95.2Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Pilonidal Cyst with 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: Misdiagnosis risk, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Training on documentation specificity, Use of templates
Impact
Reimbursement: May lead to denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation specifies 'with abscess' and whether it's a cyst or sinus.
Impact
Reimbursement: Incorrect billing can lead to claim rejections., Compliance: Violates NCCI edits., Data Quality: Misrepresentation of procedures performed.
Mitigation Strategy
Follow NCCI edits: Only bill excision codes if excision is performed.
Impact
Using non-specific codes for pilonidal cysts with abscesses.
Mitigation Strategy
Educate staff on specific coding requirements.
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 Cyst with Abscess, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pilonidal Cyst with Abscess
Use these documentation templates to ensure complete and accurate documentation for Pilonidal Cyst with Abscess. These templates include all required elements for proper coding and billing.
Emergency Department Visit
Specialty: Emergency MedicineRequired Elements
- Patient history of pain and swelling
- Physical exam findings
- Imaging results
- Procedure details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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