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ICD-10 Guide
ICD-10 CodesL56.0

L56.0

Billable

Drug phototoxic response

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

Code Description

ICD-10 L56.0 is a billable code used to indicate a diagnosis of drug phototoxic response.

Key Diagnostic Point:

L56.0 refers to drug phototoxic response, a skin reaction that occurs when certain medications are taken and the skin is subsequently exposed to sunlight. This condition is characterized by an exaggerated sunburn-like reaction, which can manifest as erythema, edema, and blistering in areas exposed to UV light. The anatomy involved primarily includes the epidermis and dermis, where the phototoxic reaction occurs due to the interaction between the drug and UV radiation. Common drugs associated with phototoxic responses include certain antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and some chemotherapeutic agents. Disease progression typically begins with an initial exposure to the drug followed by UV light, leading to symptoms that can appear within hours to days. Diagnostic considerations include a thorough patient history, identification of the offending drug, and clinical examination of the skin lesions. Patch testing may also be utilized to confirm the diagnosis. It is essential for healthcare providers to recognize this condition to prevent further exposure and manage symptoms effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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

Pharmacology

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of drug phototoxic responses lies in their potential to cause discomfort and complications for patients, leading to increased healthcare utilization. Understanding this condition can improve patient safety by preventing further drug exposure and managing symptoms effectively. Epidemiologically, awareness of drug phototoxicity is essential, as certain populations may be more susceptible due to genetic factors or concurrent medications, impacting public health strategies.

ICD-9 vs ICD-10

The clinical significance of drug phototoxic responses lies in their potential to cause discomfort and complications for patients, leading to increased healthcare utilization. Understanding this condition can improve patient safety by preventing further drug exposure and managing symptoms effectively. Epidemiologically, awareness of drug phototoxicity is essential, as certain populations may be more susceptible due to genetic factors or concurrent medications, impacting public health strategies.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the severity of the condition and the treatment provided. Common denials can occur if documentation does not adequately link the drug exposure to the skin reaction. Coding best practices include using the most specific code available and ensuring that all relevant clinical information is included in the medical record to support the claim.

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 L56.0?

L56.0 covers drug-induced phototoxic responses, which can include conditions such as phototoxic dermatitis and acute sunburn-like reactions due to specific medications. It is essential to identify the drug responsible for the reaction to manage the condition effectively.

When should L56.0 be used instead of related codes?

L56.0 should be used when the skin reaction is specifically due to a drug and exacerbated by sunlight exposure. It is important to differentiate it from L56.1, which pertains to photoallergic reactions that involve an immune response.

What documentation supports L56.0?

Documentation should include a detailed patient history, identification of the drug involved, clinical findings of the skin reaction, and any relevant laboratory tests or patch testing results that support the diagnosis of a drug phototoxic response.