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v1.0.0
ICD-10 Guide
ICD-10 CodesL74.3

L74.3

Billable

Miliaria, unspecified

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

Code Description

ICD-10 L74.3 is a billable code used to indicate a diagnosis of miliaria, unspecified.

Key Diagnostic Point:

Miliaria, also known as heat rash or prickly heat, is a skin condition characterized by the obstruction of sweat ducts, leading to the formation of small, itchy papules or vesicles. It commonly occurs in hot, humid environments and can affect individuals of all ages, particularly infants and young children. The condition arises when sweat is trapped beneath the skin due to blocked sweat glands, resulting in inflammation and irritation. Clinically, miliaria can present in various forms, including miliaria rubra (red) and miliaria crystallina (clear vesicles). The affected areas are typically located on the trunk, neck, and areas where skin rubs together. Disease progression is usually self-limiting, with symptoms resolving once the individual is moved to a cooler environment. Diagnostic considerations include a thorough clinical examination and patient history to differentiate miliaria from other dermatological conditions such as eczema or folliculitis. Treatment primarily focuses on alleviating symptoms and preventing recurrence by maintaining cool skin and avoiding excessive heat exposure.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low, as diagnosis is primarily clinical.
  • Treatment complexity: Low, with simple management strategies.
  • Documentation requirements: Moderate, requiring clear clinical notes.
  • Coding specificity: Low, as it is categorized under unspecified miliaria.

Audit Risk Factors

  • Common coding errors: Misclassification with other skin conditions.
  • Documentation gaps: Lack of detailed clinical notes on symptoms.
  • Billing challenges: Potential denials if not clearly documented.

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

Pediatrics

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, while generally benign, can significantly impact patient comfort and quality of life, particularly in vulnerable populations such as infants. Understanding and addressing this condition can lead to improved patient outcomes and reduced healthcare utilization, especially during hot weather. Awareness of miliaria can also inform public health strategies aimed at preventing heat-related illnesses, contributing to overall population health.

ICD-9 vs ICD-10

Miliaria, while generally benign, can significantly impact patient comfort and quality of life, particularly in vulnerable populations such as infants. Understanding and addressing this condition can lead to improved patient outcomes and reduced healthcare utilization, especially during hot weather. Awareness of miliaria can also inform public health strategies aimed at preventing heat-related illnesses, contributing to overall population health.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis aligns with the services provided. Common denials may arise from insufficient documentation or misclassification of the condition. Coders should ensure that the clinical notes reflect the patient's symptoms and the rationale for the diagnosis to support claims. Best practices include using specific codes when possible and maintaining thorough records of patient interactions and treatment plans.

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 L74.3?

L74.3 covers unspecified miliaria, which includes various forms of heat rash that do not fit the specific categories of miliaria rubra or crystallina. It is characterized by small, itchy bumps that can appear on the skin due to sweat duct obstruction.

When should L74.3 be used instead of related codes?

L74.3 should be used when the specific type of miliaria is not identified or documented. If the clinician specifies miliaria rubra or crystallina, the corresponding codes (L74.0 or L74.1) should be used instead.

What documentation supports L74.3?

Documentation should include a detailed clinical examination, patient history regarding exposure to heat, and descriptions of the rash. Notes should clarify that the condition is not due to other dermatological issues.