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ICD-10 Guide
ICD-10 CodesL72.1

L72.1

Non-billable

Pilar and trichodermal cyst

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

Code Description

ICD-10 L72.1 is a used to indicate a diagnosis of pilar and trichodermal cyst.

Key Diagnostic Point:

Pilar cysts, also known as trichilemmal cysts, are benign, fluid-filled sacs that typically develop on the scalp. They originate from hair follicle cells and are characterized by a keratin-filled cavity. Clinically, these cysts present as firm, smooth, and mobile nodules, often asymptomatic unless inflamed or infected. The anatomy involved includes the epidermis and dermis, where the cyst forms from the outer root sheath of hair follicles. Disease progression is generally slow, with cysts remaining stable in size; however, they can occasionally become inflamed or rupture, leading to secondary infections. Diagnostic considerations include a thorough clinical examination and, if necessary, imaging studies to differentiate them from other skin lesions. Histological examination may be required for definitive diagnosis, particularly in atypical cases. Pilar cysts are more common in women and may have a genetic predisposition, often appearing in multiple numbers in affected individuals.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate; requires differentiation from other cystic lesions.
  • Treatment complexity: Low; typically involves simple excision if symptomatic.
  • Documentation requirements: Moderate; requires clear clinical notes and possibly histological confirmation.
  • Coding specificity: High; specific to pilar cysts, differentiating from other cyst types.

Audit Risk Factors

  • Common coding errors: Misidentification of cyst type.
  • Documentation gaps: Lack of detailed clinical notes or histological evidence.
  • Billing challenges: Potential denials if the cyst is not clearly documented as a pilar cyst.

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

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Pilar cysts, while benign, can impact patient quality of life if symptomatic or infected. Their prevalence, particularly among women, highlights the need for awareness in dermatological practice. Understanding the epidemiology of pilar cysts can aid in population health strategies, as they may contribute to healthcare utilization patterns, particularly in dermatology and surgical settings.

ICD-9 vs ICD-10

Pilar cysts, while benign, can impact patient quality of life if symptomatic or infected. Their prevalence, particularly among women, highlights the need for awareness in dermatological practice. Understanding the epidemiology of pilar cysts can aid in population health strategies, as they may contribute to healthcare utilization patterns, particularly in dermatology and surgical settings.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure and the location of the cyst. Common denials may occur if the documentation does not clearly establish the diagnosis or if the procedure performed is not adequately justified. Best practices include thorough documentation and ensuring that the coding aligns with the clinical findings.

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 L72.1?

L72.1 specifically covers pilar cysts, which are benign cysts arising from hair follicles, primarily located on the scalp. They are distinct from other cyst types such as epidermoid cysts and sebaceous cysts.

When should L72.1 be used instead of related codes?

L72.1 should be used when the diagnosis is confirmed as a pilar cyst. If the cyst is epidermoid or sebaceous, then L72.0 or L72.9 should be used respectively. Accurate diagnosis is crucial for appropriate coding.

What documentation supports L72.1?

Documentation should include a detailed clinical examination note describing the cyst's characteristics, location, and any symptoms. If excision is performed, operative notes and histopathology reports confirming the diagnosis as a pilar cyst are essential.