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ICD-10 Guide
ICD-10 CodesL72.11

L72.11

Billable

Pilar cyst

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

Code Description

ICD-10 L72.11 is a billable code used to indicate a diagnosis of pilar cyst.

Key Diagnostic Point:

Pilar cysts, also known as trichilemmal cysts, are benign, fluid-filled sacs that typically develop on the scalp. They arise from hair follicles and are characterized by a keratin-filled cavity lined by stratified squamous epithelium. Clinically, these cysts present as smooth, firm, and mobile nodules, often skin-colored or slightly yellowish, and can vary in size from a few millimeters to several centimeters. They are usually asymptomatic but may become inflamed or infected, leading to discomfort. The anatomy involved primarily includes the epidermis and dermis, where the cyst forms from the outer root sheath of hair follicles. Disease progression is generally benign, with pilar cysts rarely leading to complications unless they rupture or become infected. Diagnostic considerations include a thorough clinical examination and, if necessary, imaging studies to differentiate them from other skin lesions. A biopsy may be performed for definitive diagnosis in atypical cases.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low - straightforward clinical diagnosis
  • Treatment complexity: Low - typically requires simple excision
  • Documentation requirements: Low - basic documentation of clinical findings
  • Coding specificity: Medium - specific to pilar cysts, but related codes exist

Audit Risk Factors

  • Common coding errors: Misclassification with other cyst types
  • Documentation gaps: Incomplete clinical notes regarding cyst characteristics
  • Billing challenges: Potential denials if the cyst is not documented as symptomatic

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 are common dermatological conditions that can affect a significant portion of the population, particularly adults. While they are benign, their presence can lead to psychological distress or discomfort for some patients. Understanding the epidemiology of pilar cysts can help healthcare providers address patient concerns effectively and improve overall quality of care. Monitoring and managing these conditions can also contribute to better healthcare utilization patterns.

ICD-9 vs ICD-10

Pilar cysts are common dermatological conditions that can affect a significant portion of the population, particularly adults. While they are benign, their presence can lead to psychological distress or discomfort for some patients. Understanding the epidemiology of pilar cysts can help healthcare providers address patient concerns effectively and improve overall quality of care. Monitoring and managing these conditions can also contribute to better healthcare utilization patterns.

Reimbursement & Billing Impact

reimbursement.

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 L72.11?

L72.11 specifically covers pilar cysts, which are benign cystic lesions arising from hair follicles, primarily on the scalp. It does not include other types of cysts such as sebaceous or epidermoid cysts.

When should L72.11 be used instead of related codes?

L72.11 should be used when the diagnosis is confirmed as a pilar cyst, particularly when the cyst is located on the scalp. If the cyst is sebaceous or epidermoid, then L72.0 or L72.9 should be considered.

What documentation supports L72.11?

Documentation should include a detailed clinical description of the cyst, its location, size, and any symptoms experienced by the patient. Photographic evidence and notes on the treatment plan may also be beneficial.