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ICD-10 Guide
ICD-10 CodesL03.314

L03.314

Billable

Cellulitis of groin

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

Code Description

ICD-10 L03.314 is a billable code used to indicate a diagnosis of cellulitis of groin.

Key Diagnostic Point:

Cellulitis of the groin is a bacterial skin infection that affects the skin and subcutaneous tissues in the groin area. Clinically, it presents with symptoms such as redness, swelling, warmth, and pain in the affected area, often accompanied by systemic signs like fever and malaise. The groin region, which includes the inguinal area, is particularly susceptible due to its anatomical features, including skin folds and proximity to the perineum, which can harbor bacteria. Disease progression can lead to more severe complications if left untreated, including abscess formation or systemic infection. Diagnosis is primarily clinical, supported by patient history and physical examination, though laboratory tests may be utilized to rule out other conditions. Imaging studies are rarely necessary unless complications are suspected. Prompt recognition and treatment are essential to prevent further complications and to manage the infection effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and differentiation from other skin conditions.
  • Treatment complexity: May involve antibiotics and, in some cases, surgical intervention for abscess drainage.
  • Documentation requirements: Detailed documentation of symptoms, treatment plans, and follow-up care is necessary.
  • Coding specificity: Requires accurate coding to reflect the specific site and nature of the infection.

Audit Risk Factors

  • Common coding errors: Misclassification of the site or severity of the infection.
  • Documentation gaps: Incomplete records regarding the patient's history or treatment response.
  • Billing challenges: Potential denials due to lack of supporting documentation or incorrect coding.

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 groin can significantly impact patient health, leading to increased healthcare utilization due to potential complications such as abscess formation or systemic infection. Understanding the epidemiology of cellulitis, including risk factors such as obesity and diabetes, is essential for population health management. Quality measures related to timely treatment and follow-up care can improve patient outcomes and reduce the burden on healthcare systems.

ICD-9 vs ICD-10

Cellulitis of the groin can significantly impact patient health, leading to increased healthcare utilization due to potential complications such as abscess formation or systemic infection. Understanding the epidemiology of cellulitis, including risk factors such as obesity and diabetes, is essential for population health management. Quality measures related to timely treatment and follow-up care can improve patient outcomes and reduce the burden on healthcare systems.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear documentation of the clinical findings and treatment provided. Common denials may arise from insufficient documentation or incorrect coding. It is crucial to ensure that all relevant information is included in the medical record, including the patient's history, examination findings, and treatment plan, to support the medical necessity of the services rendered. Adhering to coding best practices will help mitigate 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 L03.314?

L03.314 specifically covers cellulitis localized to the groin area, which may arise from various causes including trauma, surgical wounds, or skin conditions that compromise the integrity of the skin.

When should L03.314 be used instead of related codes?

L03.314 should be used when the infection is specifically localized to the groin area. If the infection is in another region, such as the thigh or abdomen, the corresponding codes (e.g., L03.313 or L03.312) should be utilized.

What documentation supports L03.314?

Documentation should include a detailed description of the clinical findings, treatment provided, and any relevant patient history that supports the diagnosis of cellulitis in the groin.