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ICD-10 Guide
ICD-10 CodesL02.216

L02.216

Billable

Cutaneous abscess of umbilicus

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 L02.216 is a billable code used to indicate a diagnosis of cutaneous abscess of umbilicus.

Key Diagnostic Point:

L02.216 refers to a cutaneous abscess of the umbilicus, which is a localized collection of pus within the skin or subcutaneous tissue surrounding the navel. Clinically, patients may present with symptoms such as localized pain, swelling, redness, and warmth around the umbilicus. The abscess may also be accompanied by systemic symptoms like fever or malaise if an infection is present. The anatomy involved includes the skin layers, subcutaneous tissue, and potentially deeper structures if the abscess is extensive. Disease progression can vary; if untreated, the abscess may enlarge, rupture, or lead to systemic infection. Diagnostic considerations include a thorough clinical examination, imaging studies if necessary, and laboratory tests to identify the causative organism, typically Staphylococcus aureus. Prompt diagnosis and treatment are crucial to prevent complications such as cellulitis or sepsis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires clinical evaluation and possibly imaging.
  • Treatment complexity: Moderate, involving incision and drainage, and possibly antibiotics.
  • Documentation requirements: Requires detailed documentation of clinical findings and treatment.
  • Coding specificity: Specific to cutaneous abscesses of the umbilicus, which aids in precise coding.

Audit Risk Factors

  • Common coding errors: Misclassification with other abscess codes.
  • Documentation gaps: Incomplete clinical notes regarding the abscess characteristics.
  • Billing challenges: Potential denials if documentation does not support the diagnosis.

Specialty Focus

Medical Specialties

Primary medical specialty: Dermatology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Secondary specialty: General Surgery

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of L02.216 lies in its potential to cause discomfort and systemic infection if not treated promptly. In terms of population health, umbilical abscesses can occur in various demographics, particularly in infants and individuals with compromised immune systems. Quality measures may include timely intervention and appropriate antibiotic use, while healthcare utilization patterns may reflect increased visits to urgent care or emergency departments for abscess management. Epidemiologically, understanding the incidence and risk factors for umbilical abscesses can aid in preventive strategies.

ICD-9 vs ICD-10

The clinical significance of L02.216 lies in its potential to cause discomfort and systemic infection if not treated promptly. In terms of population health, umbilical abscesses can occur in various demographics, particularly in infants and individuals with compromised immune systems. Quality measures may include timely intervention and appropriate antibiotic use, while healthcare utilization patterns may reflect increased visits to urgent care or emergency departments for abscess management. Epidemiologically, understanding the incidence and risk factors for umbilical abscesses can aid in preventive strategies.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure performed, such as incision and drainage, which may be billed using CPT codes 10060 or 10061. Common denials may arise from insufficient documentation or incorrect coding. It is advisable to maintain thorough clinical notes and ensure that the procedure performed aligns with the diagnosis to minimize billing challenges.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for L00-L99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for L00-L99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by L02.216?

L02.216 specifically covers cutaneous abscesses located at the umbilicus, which may arise from various causes including infection, obstruction of sebaceous glands, or trauma. It is important to differentiate it from other types of abdominal abscesses.

When should L02.216 be used instead of related codes?

L02.216 should be used when the abscess is specifically located at the umbilicus. If the abscess is located elsewhere on the abdomen, other codes such as L02.215 should be considered.

What documentation supports L02.216?

Documentation should include a detailed description of the abscess, including size, appearance, symptoms, and any laboratory or imaging results. Clinical notes should also reflect the treatment plan and follow-up care.