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ICD-10 Guide
ICD-10 CodesL57.1

L57.1

Billable

Actinic reticuloid

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

Code Description

ICD-10 L57.1 is a billable code used to indicate a diagnosis of actinic reticuloid.

Key Diagnostic Point:

Actinic reticuloid is a rare skin condition characterized by a photosensitive dermatitis that results from chronic sun exposure, primarily affecting individuals with a history of actinic keratosis or other sun-induced skin changes. Clinically, it presents as erythematous patches and plaques, often with a reticular pattern, typically on sun-exposed areas such as the face, neck, and arms. The condition is thought to be an immune-mediated response to solar damage, leading to a lymphocytic infiltrate in the dermis. Disease progression can vary, with some patients experiencing chronic symptoms and others developing more severe manifestations, including potential transformation into skin malignancies. Diagnosis is primarily clinical, supported by a thorough patient history and physical examination, and may be confirmed through skin biopsy showing characteristic histopathological changes. Differential diagnoses include other forms of dermatitis, such as eczema or psoriasis, and conditions like cutaneous T-cell lymphoma, necessitating careful evaluation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other skin disorders.
  • Treatment complexity: May involve topical therapies, phototherapy, or systemic medications.
  • Documentation requirements: Detailed patient history and clinical findings are essential.
  • Coding specificity: Requires accurate coding to reflect the specific condition and its manifestations.

Audit Risk Factors

  • Common coding errors: Misclassification with other dermatitis codes.
  • Documentation gaps: Incomplete patient history or lack of biopsy results.
  • Billing challenges: Potential denials if the condition is not well-documented or justified.

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

Oncology

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

Actinic reticuloid has significant clinical implications, particularly for populations with high sun exposure, such as outdoor workers and individuals with fair skin. Understanding this condition can improve patient management and reduce the risk of progression to skin cancer. Epidemiologically, it highlights the importance of sun protection and regular skin examinations, contributing to public health initiatives aimed at reducing skin cancer incidence and promoting awareness of sun safety.

ICD-9 vs ICD-10

Actinic reticuloid has significant clinical implications, particularly for populations with high sun exposure, such as outdoor workers and individuals with fair skin. Understanding this condition can improve patient management and reduce the risk of progression to skin cancer. Epidemiologically, it highlights the importance of sun protection and regular skin examinations, contributing to public health initiatives aimed at reducing skin cancer incidence and promoting awareness of sun safety.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the condition is well-documented in the medical record, including the patient's history of sun exposure and clinical findings. Common denials may occur if the documentation does not clearly establish the diagnosis or if the treatment plan is not adequately justified. Best practices include using precise coding, maintaining thorough clinical notes, and ensuring that all relevant procedures are coded accurately to reflect the patient's condition.

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 L57.1?

L57.1 specifically covers actinic reticuloid, a condition resulting from chronic sun exposure leading to photosensitive dermatitis. It is essential to differentiate it from actinic keratosis and other dermatitis types.

When should L57.1 be used instead of related codes?

L57.1 should be used when the clinical presentation aligns with actinic reticuloid, particularly when there is a history of sun exposure and characteristic skin findings. It is crucial to differentiate it from other dermatitis codes based on clinical and histological evidence.

What documentation supports L57.1?

Documentation should include a detailed patient history of sun exposure, clinical findings of erythematous patches, and any biopsy results showing lymphocytic infiltrate. Clear documentation of the treatment plan and response is also necessary.