ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesL05.01

L05.01

Billable

Pilonidal cyst with abscess

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

Code Description

ICD-10 L05.01 is a billable code used to indicate a diagnosis of pilonidal cyst with abscess.

Key Diagnostic Point:

A pilonidal cyst with abscess is a common condition that occurs in the sacrococcygeal region, characterized by the formation of a cystic structure that can become infected and filled with pus. Clinically, patients may present with pain, swelling, and tenderness in the lower back area, often accompanied by fever and malaise if an abscess develops. The anatomy involved includes the skin and subcutaneous tissue around the coccyx, where hair follicles can become obstructed, leading to the formation of the cyst. Disease progression can vary; while some patients may remain asymptomatic, others may experience recurrent infections and complications. Diagnostic considerations include a thorough physical examination, imaging studies such as ultrasound if the abscess is suspected, and sometimes aspiration to confirm the presence of pus. Treatment typically involves incision and drainage of the abscess, and in recurrent cases, surgical excision of the cyst may be necessary to prevent future occurrences.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires clinical evaluation and sometimes imaging.
  • Treatment complexity: Moderate, involving both conservative and surgical management options.
  • Documentation requirements: Requires detailed clinical notes and possibly imaging reports.
  • Coding specificity: Specific to pilonidal cysts with abscess, necessitating accurate coding to reflect the condition.

Audit Risk Factors

  • Common coding errors: Misidentification of the condition, especially differentiating between cysts with and without abscess.
  • Documentation gaps: Incomplete clinical notes regarding the presence of abscess or treatment details.
  • Billing challenges: Potential denials if the documentation does not clearly support the diagnosis and 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: 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

Pilonidal cysts with abscesses can significantly impact patient quality of life, leading to pain and recurrent healthcare visits. They are more prevalent in certain populations, particularly young adults and those with sedentary lifestyles. Understanding the epidemiology of this condition can help healthcare providers implement preventive measures and improve management strategies, ultimately reducing healthcare utilization and enhancing patient outcomes.

ICD-9 vs ICD-10

Pilonidal cysts with abscesses can significantly impact patient quality of life, leading to pain and recurrent healthcare visits. They are more prevalent in certain populations, particularly young adults and those with sedentary lifestyles. Understanding the epidemiology of this condition can help healthcare providers implement preventive measures and improve management strategies, ultimately reducing healthcare utilization and enhancing patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure performed, such as incision and drainage versus surgical excision. Common denials may arise from insufficient documentation of the abscess or lack of clarity in the treatment plan. Best practices include ensuring that all clinical notes are thorough and that the coding accurately reflects the services rendered to minimize audit risks.

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 L05.01?

L05.01 specifically covers pilonidal cysts that have developed into an abscess. This includes cases where the cyst is inflamed, infected, and filled with pus, leading to significant discomfort and potential systemic symptoms.

When should L05.01 be used instead of related codes?

L05.01 should be used when there is clear evidence of an abscess associated with a pilonidal cyst. If the cyst is present without signs of infection or abscess formation, L05.00 should be utilized instead.

What documentation supports L05.01?

Documentation should include a detailed clinical examination noting the presence of an abscess, any imaging studies performed, treatment plans, and follow-up notes that indicate the management of the abscess.