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ICD-10 Guide
ICD-10 CodesChapter 12: Diseases of the skin and subcutaneous tissueL42

L42

Billable

Pityriasis rosea

Chapter 12:Diseases of the skin and subcutaneous tissue

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 L42 is a billable code used to indicate a diagnosis of pityriasis rosea.

Key Diagnostic Point:

Pityriasis rosea is a common skin condition characterized by a distinctive rash that typically begins with a single, large patch known as a herald patch, followed by smaller lesions that develop in a Christmas tree pattern on the trunk and limbs. The exact cause of pityriasis rosea is not well understood, but it is believed to be related to viral infections, particularly human herpesvirus 6 and 7. The condition is usually self-limiting, resolving within 6 to 8 weeks without treatment, although symptomatic relief may be provided for itching or discomfort. It is important for healthcare providers to differentiate pityriasis rosea from other skin conditions, such as psoriasis or tinea corporis, to ensure appropriate management and avoid unnecessary interventions.

  • Clinically, pityriasis rosea is significant due to its self-limiting nature and the potential for misdiagnosis. The condition is most commonly seen in adolescents and young adults, and while it is generally benign, it can cause anxiety in patients due to its appearance. Usage guidelines for coding L42 include documenting the characteristic rash and any associated symptoms, as well as ruling out other dermatological conditions. Accurate coding is essential for proper reimbursement and to ensure that patients receive appropriate care for their condition.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Commonly diagnosed
  • Self-limiting nature
  • Clear clinical presentation

Audit Risk Factors

  • Misdiagnosis with other skin conditions
  • Inadequate documentation of symptoms
  • Failure to follow up on resolution of symptoms

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

Primary Care

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 CPT Codes

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CPT Code

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ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical impact of coding for pityriasis rosea (L42) lies in its ability to accurately reflect the prevalence of this condition in the patient population, which can inform public health initiatives and resource allocation. Understanding the demographics affected by pityriasis rosea can help healthcare providers develop targeted educational materials and interventions to support patients experiencing this condition. Additionally, accurate coding contributes to quality measures in dermatology, allowing for better tracking of patient outcomes and treatment effectiveness.
From an administrative perspective, the coding of L42 can influence healthcare trends by providing insights into the burden of skin conditions on the healthcare system. As more data is collected on the incidence and management of pityriasis rosea, healthcare organizations can better understand the need for dermatological services and allocate resources accordingly. This can lead to improved patient care and outcomes, as well as enhanced awareness of skin health issues within the broader healthcare landscape.

ICD-9 vs ICD-10

The clinical impact of coding for pityriasis rosea (L42) lies in its ability to accurately reflect the prevalence of this condition in the patient population, which can inform public health initiatives and resource allocation. Understanding the demographics affected by pityriasis rosea can help healthcare providers develop targeted educational materials and interventions to support patients experiencing this condition. Additionally, accurate coding contributes to quality measures in dermatology, allowing for better tracking of patient outcomes and treatment effectiveness. From an administrative perspective, the coding of L42 can influence healthcare trends by providing insights into the burden of skin conditions on the healthcare system. As more data is collected on the incidence and management of pityriasis rosea, healthcare organizations can better understand the need for dermatological services and allocate resources accordingly. This can lead to improved patient care and outcomes, as well as enhanced awareness of skin health issues within the broader healthcare...

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the visit and the level of service provided. Additionally, ensuring that the diagnosis is clearly linked to the services rendered can help prevent denials and ensure appropriate payment.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for L42

Coding & Billing References

  • •
    Official ICD-10 Guidelines for L42

Frequently Asked Questions

What conditions are included in L42?

L42 specifically covers pityriasis rosea, which is characterized by a specific rash pattern and is distinct from other skin disorders.

When should I use L42 codes?

L42 codes should be used when a patient presents with the characteristic symptoms of pityriasis rosea, including the herald patch and subsequent rash, after ruling out other conditions.

What documentation is required for L42?

Documentation should include a description of the rash, any associated symptoms such as itching, and a note on the duration of the condition, along with any differential diagnoses considered.