ICD-10 Coding for Scar(L90.5, L91.0)
Complete ICD-10-CM coding and documentation guide for Scar. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Scar
L90-L99Primary Range
Other disorders of skin and subcutaneous tissue
This range includes codes for various skin conditions, including scars and fibrosis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| L90.5 | Scar conditions and fibrosis of skin | Use for general scars, adhesions, and fibrosis not specified as hypertrophic or keloid. |
|
| L91.0 | Hypertrophic scar | Use for elevated, firm scars that are hypertrophic or keloid. |
|
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 hypertrophic scar
Essential facts and insights about Scar
Primary ICD-10-CM Codes for scar
Decision Criteria
clinical Criteria
- Scar is flat, atrophic, or fibrotic without hypertrophy.
Applicable To
- Cicatrix
- Fibrosis of skin
Excludes
- Hypertrophic scar (L91.0)
Clinical Validation Requirements
- Documentation of fibrosis on ultrasound
- Restricted mobility on physical exam
Code-Specific Risks
- Confusing with hypertrophic scars
- Missing etiology documentation
Coding Notes
- Ensure documentation specifies the type and etiology of the scar.
L91.0 - Hypertrophic scar
Use for elevated, firm scars that are hypertrophic or keloid.
Applicable To
- Keloid
Excludes
- Scar conditions and fibrosis of skin (L90.5)
Clinical Validation Requirements
- Biopsy confirming collagen overproduction
- Imaging showing dermal thickening
Coding Notes
Document the scar's hypertrophic nature and etiology.
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 Scar to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code L90.5.
Impact
Clinical: Misleading clinical history, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Review coding guidelines, Use sequela codes for healed injuries
Impact
Reimbursement: Incorrect DRG assignment, Compliance: Non-compliance with ICD-10 guidelines, Data Quality: Inaccurate patient records
Mitigation Strategy
Ensure the injury code includes the 7th character 'S' for sequela.
Impact
Failure to use the 7th character 'S' for sequela can lead to audit issues.
Mitigation Strategy
Educate coders on sequela coding 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 Scar, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Scar
Use these documentation templates to ensure complete and accurate documentation for Scar. These templates include all required elements for proper coding and billing.
Hypertrophic Scar Documentation
Specialty: DermatologyRequired Elements
- Type of scar
- Location and laterality
- Etiology
- Functional impact
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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