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ICD-10 Guide
ICD-10 CodesL02.226

L02.226

Billable

Furuncle of umbilicus

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

Code Description

ICD-10 L02.226 is a billable code used to indicate a diagnosis of furuncle of umbilicus.

Key Diagnostic Point:

L02.226 refers to a furuncle (boil) located at the umbilicus, which is the central point of the abdomen where the umbilical cord was attached in utero. Clinically, a furuncle is a painful, pus-filled bump that arises from an infected hair follicle, often caused by Staphylococcus aureus. The condition typically presents as a red, swollen area that may be tender to touch, and it can lead to systemic symptoms such as fever if the infection spreads. The umbilicus is a unique anatomical site that can be prone to infections due to moisture retention and the presence of hair follicles. Disease progression can vary; if untreated, a furuncle may rupture, leading to the spread of infection or the formation of an abscess. Diagnostic considerations include a thorough clinical examination and, if necessary, laboratory tests to identify the causative organism. Differential diagnoses may include other skin infections such as cellulitis or abscesses. Prompt diagnosis and treatment are essential to prevent complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires differentiation from other skin conditions.
  • Treatment complexity: Moderate, as it may require incision and drainage or antibiotics.
  • Documentation requirements: Requires clear documentation of symptoms, examination findings, and treatment plan.
  • Coding specificity: Specific to furuncle at the umbilicus, which aids in accurate coding.

Audit Risk Factors

  • Common coding errors: Misclassification with other skin infections.
  • Documentation gaps: Incomplete records of symptoms or treatment.
  • Billing challenges: Potential denials if the documentation does not support the diagnosis.

Specialty Focus

Medical Specialties

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

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of L02.226 lies in its potential to cause discomfort and complications if left untreated. Population health impact includes the need for effective management of skin infections to prevent systemic spread. Quality measures may focus on timely diagnosis and treatment to reduce the incidence of complications. Healthcare utilization patterns may reflect increased visits for skin infections, emphasizing the importance of education on hygiene and skin care to prevent such conditions. Epidemiologically, furuncles can occur in various populations, particularly in those with compromised immune systems or poor hygiene.

ICD-9 vs ICD-10

The clinical significance of L02.226 lies in its potential to cause discomfort and complications if left untreated. Population health impact includes the need for effective management of skin infections to prevent systemic spread. Quality measures may focus on timely diagnosis and treatment to reduce the incidence of complications. Healthcare utilization patterns may reflect increased visits for skin infections, emphasizing the importance of education on hygiene and skin care to prevent such conditions. Epidemiologically, furuncles can occur in various populations, particularly in those with compromised immune systems or poor hygiene.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the procedure codes for any interventions, such as incision and drainage, are accurately linked to the diagnosis. Common denials may arise from insufficient documentation or misalignment between the diagnosis and procedure codes. Best practices include maintaining thorough records and ensuring that all documentation supports the medical necessity of the treatment provided.

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 L02.226?

L02.226 specifically covers furuncles located at the umbilicus, which are typically caused by bacterial infections of hair follicles. It does not cover other types of skin infections or lesions.

When should L02.226 be used instead of related codes?

L02.226 should be used when the furuncle is specifically located at the umbilicus. If the furuncle is located elsewhere, other codes such as L02.225 or L02.229 should be considered.

What documentation supports L02.226?

Documentation should include a detailed description of the lesion, clinical findings, treatment provided, and any relevant laboratory results that support the diagnosis of a furuncle at the umbilicus.