ICD-10 Coding for Pilonidal Disease(L05.01, L05.02, L05.91, L05.92)
Complete ICD-10-CM coding and documentation guide for Pilonidal Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pilonidal Disease
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 there is an acute pilonidal abscess with purulent drainage. |
|
| L05.02 | Pilonidal sinus without abscess | Use for chronic sinus tracts without active purulence. |
|
| L05.91 | Pilonidal cyst without abscess | Use for non-tender cysts without signs of infection. |
|
| L05.92 | Pilonidal sinus with serous drainage | Use for chronic sinuses with serous or serosanguinous discharge. |
|
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 disease
Essential facts and insights about Pilonidal Disease
Primary ICD-10-CM Codes for pilonidal disease
Decision Criteria
clinical Criteria
- Presence of purulent drainage and fluctuant mass
Applicable To
- Acute pilonidal abscess
Excludes
- Congenital sacral dimple (Q82.6)
Clinical Validation Requirements
- Acute inflammation
- Purulent drainage
- Fluctuance
Code-Specific Risks
- Confusion with general abscess codes
Coding Notes
- Ensure documentation specifies 'pilonidal' to avoid confusion with other abscess codes.
L05.02 - Pilonidal sinus without abscess
Use for chronic sinus tracts without active purulence.
Applicable To
- Chronic pilonidal sinus
Excludes
- Congenital sacral dimple (Q82.6)
Clinical Validation Requirements
- Chronic sinus tract
- Granulation tissue
Coding Notes
Document the absence of abscess to differentiate from L05.01.
L05.91 - Pilonidal cyst without abscess
Use for non-tender cysts without signs of infection.
Applicable To
- Non-tender pilonidal cyst
Excludes
- Congenital sacral dimple (Q82.6)
Clinical Validation Requirements
- Palpable cyst
- No drainage
Coding Notes
Ensure no signs of infection are documented.
L05.92 - Pilonidal sinus with serous drainage
Use for chronic sinuses with serous or serosanguinous discharge.
Applicable To
- Chronic draining pilonidal sinus
Excludes
- Congenital sacral dimple (Q82.6)
Clinical Validation Requirements
- Epithelialized tract
- Serous drainage
Coding Notes
Document the nature of the drainage to differentiate from abscess codes.
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
B95.6Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Pilonidal Disease 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 misdiagnosis and inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to insufficient documentation.
Mitigation Strategy
Train staff on specific documentation requirements., Use templates to ensure all necessary details are captured.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Ensure documentation specifies 'pilonidal' to use L05.01.
Impact
Using L02.31 instead of L05.01 for pilonidal abscesses.
Mitigation Strategy
Educate coders on the specific criteria for pilonidal disease codes.
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 Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pilonidal Disease
Use these documentation templates to ensure complete and accurate documentation for Pilonidal Disease. These templates include all required elements for proper coding and billing.
Pilonidal abscess with drainage
Specialty: General SurgeryRequired Elements
- Location and size of abscess
- Characteristics of drainage
- Presence of cellulitis
- Procedure performed
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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