ICD-10 Coding for Pilonidal Cyst(L05.01, L05.02, L05.91, L05.92)
Complete ICD-10-CM coding and documentation guide for Pilonidal Cyst. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pilonidal Cyst
L05.0-L05.9Primary Range
Pilonidal cyst and sinus
This range includes all codes related to pilonidal cysts and sinuses, with or without abscess.
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 present with an abscess confirmed by clinical or imaging findings. |
|
| L05.02 | Pilonidal sinus with abscess | Use when a pilonidal sinus is present with an abscess. |
|
| L05.91 | Pilonidal cyst without abscess | Use for chronic or recurrent pilonidal cysts without active infection. |
|
| L05.92 | Pilonidal sinus without abscess | Use for pilonidal sinuses without 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 cyst with abscess
Essential facts and insights about Pilonidal Cyst
Primary ICD-10-CM Codes for pilonidal cyst
Decision Criteria
clinical Criteria
- Presence of purulent drainage and fluctuant mass
Applicable To
- Pilonidal cyst with purulent drainage
- Fluctuant mass in sacrococcygeal region
Clinical Validation Requirements
- Ultrasound showing abscess
- WBC count >12,000/µL
Code-Specific Risks
- Misclassification if abscess is not documented
- Incorrect DRG assignment
Coding Notes
- Ensure documentation specifies 'abscess' to avoid incorrect coding.
L05.02 - Pilonidal sinus with abscess
Use when a pilonidal sinus is present with an abscess.
Applicable To
- Draining sinus tract
- Fistula opening with cellulitis
Excludes
- Anal fistula (K60.5)
Clinical Validation Requirements
- MRI showing sinus tracts
- Clinical evidence of fistula
Coding Notes
Document sinus tract details to support coding.
L05.91 - Pilonidal cyst without abscess
Use for chronic or recurrent pilonidal cysts without active infection.
Applicable To
- Chronic or recurrent cyst
- Non-tender cyst
Clinical Validation Requirements
- History of prior drainage
- No current signs of infection
Coding Notes
Ensure absence of abscess is documented.
L05.92 - Pilonidal sinus without abscess
Use for pilonidal sinuses without abscess.
Applicable To
- Asymptomatic sinus
- Chronic serous drainage
Clinical Validation Requirements
- MRI or clinical exam confirming sinus without abscess
Coding Notes
Document sinus characteristics clearly.
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 Cyst 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 diagnosis coding., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Use specific terms like 'abscess' or 'sinus'., Include imaging or lab results.
Impact
Reimbursement: Incorrect DRG assignment leading to potential revenue loss., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Query provider to confirm abscess presence and use L05.01 or L05.02 as appropriate.
Impact
Reimbursement: Potential claim denial or audit risk., Compliance: Violation of NCCI bundling rules., Data Quality: Misleading procedural data.
Mitigation Strategy
Only report excision codes if I&D is part of the excision procedure.
Impact
Incorrect use of I&D and excision codes together.
Mitigation Strategy
Educate providers on NCCI edits and bundling rules.
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 expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pilonidal Cyst
Use these documentation templates to ensure complete and accurate documentation for Pilonidal Cyst. These templates include all required elements for proper coding and billing.
Excision of Pilonidal Cyst with Flap Closure
Specialty: Colorectal SurgeryRequired Elements
- Cyst dimensions
- Sinus tract details
- Closure method
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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