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v1.0.0
ICD-10 Guide
DiagnosesAcne

Acne

ICD-10 Coding for Acne(L70.0, L70.1, L70.5)

PRIMARY SPECIALTYDermatology
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Acne?
Acne is a common dermatological condition characterized by the presence of comedones, papules, pustules, and sometimes cysts, primarily affecting the face, back, and shoulders. It arises from the interplay of increased sebum production, follicular hyperkeratinization, and the presence of Propionibacterium acnes. Key clinical points include: 1) Acne can occur at any age but is most prevalent during adolescence; 2) Hormonal fluctuations, particularly androgens, can exacerbate the condition; 3) Acne can lead to psychological distress and scarring if not treated appropriately. Typical use cases for this diagnosis code include patients presenting with inflammatory lesions, non-inflammatory lesions, or a combination of both. The pathophysiology involves the obstruction of hair follicles, leading to inflammation and secondary bacterial infection. Clinical presentation may vary from mild comedonal acne to severe cystic acne requiring systemic treatment.

Key Clinical Considerations:

  • Diagnosis is based on clinical examination and the presence of typical lesions such as comedones, papules, and pustules.
  • Signs include oily skin, inflammatory lesions, and potential scarring; symptoms may include pain or tenderness in affected areas.
  • Resolution criteria include the reduction of inflammatory lesions and improvement in skin appearance.
  • Laboratory findings are typically not required; however, hormonal assays may be indicated in cases of suspected endocrine disorders.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Documentation must include the type and location of lesions, duration of symptoms, and any previous treatments.
  • Compliant documentation: 'Patient presents with multiple inflammatory lesions on the face and back, consistent with moderate acne.' Non-compliant: 'Patient has skin issues.'
  • Template phrases: 'Patient diagnosed with acne based on clinical findings of papules and pustules on the face.'
  • Medical necessity documentation should justify the need for treatment based on severity and impact on quality of life.

Coding Guidelines

Usage Guidelines & Examples

  • Use L70.0 for comedonal acne, L70.1 for inflammatory acne, and L70.5 for other specified acne types. For example, use L70.1 for a patient with pustular acne.
  • Do not use these codes for conditions like rosacea or folliculitis, which have different treatment protocols.
  • Correct usage: L70.0 for a patient with non-inflammatory acne; incorrect: L70.1 for the same patient.
  • Common errors include using the wrong subtype of acne; ensure accurate assessment of lesion types.

Code Exclusions

Important Exclusions

  • Excluded conditions include rosacea (L71) and hidradenitis suppurativa (L73.0) due to differing pathophysiology.
  • Alternative codes for exclusions include L71 for rosacea and L73 for folliculitis.
  • Common exclusion errors occur when acne is misdiagnosed as rosacea; ensure clear documentation of lesion characteristics.
  • Certain conditions are excluded to maintain coding specificity and ensure accurate treatment pathways.

Related ICD-10 Codes

Primary Codes
L70.0
Comedonal acne
L70.1
Inflammatory acne
L70.5
Other specified acne
Ancillary Codes
F41.1
Differential Codes
L71.9
L73.0
L98.1

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Dermatology

Specialty Applications

  • This diagnosis applies to patients with acne vulgaris, acne conglobata, and acne fulminans.
  • Appropriate clinical scenarios include adolescents with facial acne and adults with persistent acne.
  • Coding considerations vary by setting; outpatient dermatology clinics frequently manage acne, while inpatient settings may address complications.
  • Specialty-specific considerations include the need for dermatological expertise in treatment planning.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Acne diagnosed based on clinical findings of papules and pustules on the face.'

Template 2

Template: 'Patient presents with multiple inflammatory lesions consistent with moderate acne.'

Template 3

Template: 'Diagnostic criteria met: presence of comedones and inflammatory lesions on the back.'

Template 4

Template: 'Treatment plan includes topical retinoids and oral antibiotics for acne management.'

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this code?

Detailed documentation should include lesion type, location, duration, and treatment history.

When should this code be used vs similar codes?

Use specific codes based on lesion type; for example, use L70.1 for inflammatory lesions.

What are common billing issues with this code?

Reimbursement may be denied if documentation does not support the severity or necessity of treatment.

What procedures are commonly associated?

Commonly associated CPT codes include 99203 for office visits and 17000 for destruction of lesions.