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ICD-10 Guide
ICD-10 CodesL74.2

L74.2

Billable

Miliaria profunda

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

Code Description

ICD-10 L74.2 is a billable code used to indicate a diagnosis of miliaria profunda.

Key Diagnostic Point:

Miliaria profunda, commonly referred to as heat rash or prickly heat, is a skin condition that occurs when sweat glands become blocked, leading to the retention of sweat beneath the skin. This condition typically presents as small, red, itchy bumps or blisters, often in areas where sweat accumulates, such as the back, chest, and neck. The anatomy involved includes the eccrine sweat glands, which are responsible for thermoregulation through sweat production. Disease progression can vary; while it may resolve spontaneously with cooling and avoidance of heat, persistent cases can lead to secondary infections or chronic irritation. Diagnostic considerations include a thorough clinical examination and patient history, particularly regarding exposure to heat and humidity, as well as any prior episodes of miliaria. Differential diagnoses may include other dermatological conditions such as folliculitis or contact dermatitis, necessitating careful evaluation to ensure accurate diagnosis and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires differentiation from other skin conditions.
  • Treatment complexity: Low, typically managed with conservative measures.
  • Documentation requirements: Moderate, necessitating detailed patient history and clinical findings.
  • Coding specificity: Medium, as it is specific to a particular type of miliaria.

Audit Risk Factors

  • Common coding errors: Misclassification with other miliaria types.
  • Documentation gaps: Incomplete patient history or lack of clinical findings.
  • Billing challenges: Potential denials if the condition is not well-documented or if treatment is deemed unnecessary.

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

Primary Care

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

Miliaria profunda can significantly impact patient quality of life, particularly in hot and humid climates where it is more prevalent. Understanding this condition is crucial for healthcare providers to implement effective management strategies, thereby reducing healthcare utilization related to secondary infections or complications. Epidemiologically, it highlights the importance of public health education regarding heat-related skin conditions, especially in vulnerable populations.

ICD-9 vs ICD-10

Miliaria profunda can significantly impact patient quality of life, particularly in hot and humid climates where it is more prevalent. Understanding this condition is crucial for healthcare providers to implement effective management strategies, thereby reducing healthcare utilization related to secondary infections or complications. Epidemiologically, it highlights the importance of public health education regarding heat-related skin conditions, especially in vulnerable populations.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of the visit and the appropriateness of the treatment provided. Common denials may arise from insufficient documentation or if the condition is not clearly established as medically necessary. Best practices include ensuring that all relevant clinical findings are documented and that the treatment aligns with established guidelines for managing miliaria profunda.

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 L74.2?

L74.2 specifically covers miliaria profunda, which is characterized by deep-seated vesicles and papules due to sweat retention. It is important to differentiate it from other types of miliaria, such as L74.0 and L74.1, which involve superficial sweat gland blockage.

When should L74.2 be used instead of related codes?

L74.2 should be used when the clinical presentation indicates deeper sweat gland involvement, particularly when the patient exhibits symptoms of miliaria profunda. Accurate differentiation from other miliaria types is crucial for appropriate coding.

What documentation supports L74.2?

Documentation should include a detailed clinical examination, patient history regarding exposure to heat, and any previous episodes of miliaria. Photographic evidence may also support the diagnosis, along with treatment notes indicating the management approach.