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ICD-10 Guide
ICD-10 CodesL02.43

L02.43

Non-billable

Carbuncle of limb

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

Code Description

ICD-10 L02.43 is a used to indicate a diagnosis of carbuncle of limb.

Key Diagnostic Point:

A carbuncle of the limb is a painful cluster of boils that occurs when multiple hair follicles become infected, leading to the formation of a deep, pus-filled abscess. Clinically, it presents as a red, swollen area on the skin that is tender to touch, often accompanied by systemic symptoms such as fever and malaise. The anatomy involved primarily includes the skin and subcutaneous tissue, particularly in areas with hair follicles. Disease progression typically starts with localized inflammation and can lead to the formation of a larger abscess if not treated promptly. Diagnostic considerations include a thorough clinical examination and, if necessary, cultures to identify the causative organism, often Staphylococcus aureus. Differential diagnoses may include other skin infections such as folliculitis or cellulitis. Prompt diagnosis and treatment are crucial to prevent complications such as systemic infection or scarring.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and possible laboratory tests.
  • Treatment complexity: May involve incision and drainage, antibiotics, and wound care.
  • Documentation requirements: Detailed clinical notes and treatment plans are necessary.
  • Coding specificity: Requires accurate identification of the site and type of infection.

Audit Risk Factors

  • Common coding errors: Misidentification of the site or type of infection.
  • Documentation gaps: Incomplete clinical notes regarding the extent of the infection.
  • Billing challenges: Potential denials if documentation does not support the severity or treatment provided.

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: Infectious Disease

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

Carbuncles can significantly impact patient quality of life due to pain and discomfort, and they may lead to increased healthcare utilization if complications arise. Understanding the epidemiology of skin infections, including carbuncles, is crucial for public health initiatives aimed at reducing the incidence of such conditions. Effective management and coding of these cases can improve population health outcomes and enhance the quality of care provided.

ICD-9 vs ICD-10

Carbuncles can significantly impact patient quality of life due to pain and discomfort, and they may lead to increased healthcare utilization if complications arise. Understanding the epidemiology of skin infections, including carbuncles, is crucial for public health initiatives aimed at reducing the incidence of such conditions. Effective management and coding of these cases can improve population health outcomes and enhance the quality of care provided.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the treatment provided, such as whether incision and drainage were performed. Common denials may arise from insufficient documentation or coding errors, particularly if the site of the infection is not clearly indicated. Best practices include maintaining thorough clinical notes and ensuring that the CPT codes used align with the diagnosis and treatment rendered.

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 L02.43?

L02.43 specifically covers carbuncles located on the limb, which are characterized by multiple interconnected boils caused by bacterial infection, primarily affecting hair follicles.

When should L02.43 be used instead of related codes?

L02.43 should be used when the clinical presentation is consistent with a carbuncle on the limb, differentiating it from other skin infections such as abscesses or cellulitis, which have their own specific codes.

What documentation supports L02.43?

Documentation should include a detailed description of the lesion, clinical findings, treatment provided, and any laboratory results that confirm the diagnosis of a carbuncle.