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ICD-10 Guide
ICD-10 CodesL03.115

L03.115

Billable

Cellulitis of right lower limb

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

Code Description

ICD-10 L03.115 is a billable code used to indicate a diagnosis of cellulitis of right lower limb.

Key Diagnostic Point:

Cellulitis of the right lower limb is an acute bacterial infection of the skin and subcutaneous tissues, characterized by redness, swelling, warmth, and pain in the affected area. The condition typically arises from breaks in the skin, such as cuts, insect bites, or surgical wounds, allowing bacteria, most commonly Streptococcus and Staphylococcus species, to enter. Clinically, patients may present with systemic symptoms such as fever and chills, alongside localized signs of inflammation. The right lower limb anatomy includes the skin, subcutaneous fat, fascia, and muscles, all of which can be affected by the infection. Disease progression can lead to complications such as abscess formation, necrotizing fasciitis, or sepsis if left untreated. Diagnostic considerations involve a thorough clinical examination, patient history, and may include imaging studies to rule out abscesses. Laboratory tests, such as blood cultures, may also be warranted in severe cases to identify the causative organism and guide antibiotic therapy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and sometimes imaging.
  • Treatment complexity: May involve antibiotics and, in severe cases, surgical intervention.
  • Documentation requirements: Detailed documentation of symptoms, treatment plans, and follow-up.
  • Coding specificity: Requires precise coding to differentiate from other types of cellulitis.

Audit Risk Factors

  • Common coding errors: Misidentification of the limb involved or confusion with other skin infections.
  • Documentation gaps: Incomplete records of patient history or treatment response.
  • Billing challenges: Denials may arise from insufficient documentation supporting the diagnosis.

Specialty Focus

Medical Specialties

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

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

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Cellulitis of the right lower limb has significant clinical implications, as it can lead to serious complications if not treated promptly. The condition is prevalent in populations with comorbidities such as diabetes and obesity, impacting healthcare utilization patterns. Quality measures often focus on timely diagnosis and treatment to prevent complications, highlighting the importance of effective management in reducing hospitalizations and improving patient outcomes.

ICD-9 vs ICD-10

Cellulitis of the right lower limb has significant clinical implications, as it can lead to serious complications if not treated promptly. The condition is prevalent in populations with comorbidities such as diabetes and obesity, impacting healthcare utilization patterns. Quality measures often focus on timely diagnosis and treatment to prevent complications, highlighting the importance of effective management in reducing hospitalizations and improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the infection and the complexity of care. Common denials may occur if documentation does not clearly establish the diagnosis or if the treatment provided is not adequately justified. Best practices include ensuring that all clinical notes are thorough and that any imaging or lab results are included in the patient record to support the coding.

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 L03.115?

L03.115 specifically covers cellulitis of the right lower limb, which includes infections of the skin and subcutaneous tissue. It does not cover other types of skin infections such as abscesses or ulcers.

When should L03.115 be used instead of related codes?

L03.115 should be used when the diagnosis is specifically cellulitis of the right lower limb. If the infection is on the left limb or another area, the corresponding codes (e.g., L03.116 for the left lower limb) should be utilized.

What documentation supports L03.115?

Documentation should include a detailed clinical assessment, evidence of localized symptoms such as erythema and edema, treatment plans, and any laboratory results that support the diagnosis of cellulitis.