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ICD-10 Guide
ICD-10 CodesL70.1

L70.1

Billable

Acne conglobata

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

Code Description

ICD-10 L70.1 is a billable code used to indicate a diagnosis of acne conglobata.

Key Diagnostic Point:

Acne conglobata is a severe form of acne characterized by the presence of large, inflamed nodules and cysts that can coalesce to form abscesses. It primarily affects the face, back, and shoulders, where sebaceous glands are most active. The condition is often associated with significant scarring and can lead to psychological distress due to its appearance. The pathophysiology involves the obstruction of hair follicles, leading to the proliferation of Propionibacterium acnes and an inflammatory response. Disease progression can vary, with some patients experiencing intermittent flare-ups, while others may have persistent lesions. Diagnosis is primarily clinical, based on the characteristic appearance of the skin lesions, and may be supported by a patient history of acne vulgaris or family history of similar conditions. Differential diagnoses include hidradenitis suppurativa and other forms of severe acne. Treatment typically involves systemic therapies such as isotretinoin, antibiotics, and hormonal treatments, which require careful monitoring due to potential side effects.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough clinical evaluation and differentiation from other skin disorders.
  • Treatment complexity: Involves multi-modal approaches and potential side effects from systemic treatments.
  • Documentation requirements: Detailed clinical notes and treatment plans are essential for proper coding.
  • Coding specificity: Requires precise coding to reflect the severity and specific characteristics of the condition.

Audit Risk Factors

  • Common coding errors: Misclassification with less severe acne codes.
  • Documentation gaps: Incomplete patient histories or treatment plans can lead to denials.
  • Billing challenges: High cost of treatments may lead to scrutiny from payers.

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

Endocrinology

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

Acne conglobata significantly impacts affected individuals, leading to physical discomfort and psychological distress. It is more prevalent in young adults and can affect quality of life due to its visible nature. Understanding its epidemiology is crucial for healthcare providers, as it can lead to increased healthcare utilization, including dermatology consultations and systemic treatments. Quality measures may focus on timely diagnosis and effective management to minimize scarring and improve patient outcomes.

ICD-9 vs ICD-10

Acne conglobata significantly impacts affected individuals, leading to physical discomfort and psychological distress. It is more prevalent in young adults and can affect quality of life due to its visible nature. Understanding its epidemiology is crucial for healthcare providers, as it can lead to increased healthcare utilization, including dermatology consultations and systemic treatments. Quality measures may focus on timely diagnosis and effective management to minimize scarring and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the use of systemic therapies, which may be subject to prior authorization. Common denials can occur if documentation does not clearly support the diagnosis or if the treatment plan is not adequately detailed. Best practices include maintaining comprehensive records of patient visits, treatment responses, and any referrals to specialists, ensuring that all relevant information is included in claims submissions.

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 L70.1?

L70.1 specifically covers acne conglobata, which is characterized by the presence of painful, inflamed nodules and cysts, often leading to scarring. It is distinct from other forms of acne due to its severity and potential for systemic involvement.

When should L70.1 be used instead of related codes?

L70.1 should be used when the clinical presentation includes severe nodular acne with significant inflammation and potential for scarring. It is important to differentiate it from L70.0 (Acne vulgaris) and L70.9 (Acne, unspecified) based on the severity and specific characteristics of the lesions.

What documentation supports L70.1?

Documentation should include a detailed clinical assessment of the skin lesions, treatment history, and any associated symptoms. Photographic evidence may also be beneficial, along with notes on the impact of the condition on the patient's quality of life.