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v1.0.0
ICD-10 Guide
DiagnosesAcne Vulgaris

Acne Vulgaris

ICD-10 Coding for Acne Vulgaris(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 Vulgaris?
Acne Vulgaris is a common skin condition characterized by the presence of comedones, papules, pustules, and sometimes cysts primarily on the face, back, and shoulders. It is most prevalent in adolescents but can occur at any age. Key clinical points include: 1) It is caused by the overproduction of sebum, clogged hair follicles, and the presence of Propionibacterium acnes. 2) Hormonal changes, particularly during puberty, 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 the pilosebaceous unit, leading to inflammation and secondary bacterial infection. Clinically, patients may present with varying degrees of severity, from mild comedonal acne to severe cystic acne requiring systemic therapy.

Key Clinical Considerations:

  • Diagnosis is based on clinical examination and the presence of characteristic lesions.
  • Signs include open and closed comedones, inflammatory papules, pustules, and nodules.
  • Resolution criteria include a significant reduction in lesions and improvement in skin appearance.
  • Laboratory findings are generally 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, and previous treatments.
  • Compliant documentation: 'Patient presents with multiple inflammatory lesions on the face and back.' Non-compliant: 'Patient has acne.'
  • Template phrases: 'Acne vulgaris diagnosed based on clinical findings of comedones and pustules.'
  • Medical necessity must be established through documentation of the impact on the patient's quality of life.

Coding Guidelines

Usage Guidelines & Examples

  • Use this code for patients with moderate to severe acne requiring treatment. Example: A patient with multiple cystic lesions on the face.
  • Do not use this code for non-acneiform eruptions or other skin conditions like rosacea.
  • Correct usage: L70.0 for comedonal acne; incorrect usage: L70.9 for unspecified acne.
  • Common errors include misclassifying acne severity; ensure accurate assessment of lesion types.

Code Exclusions

Important Exclusions

  • Excluded conditions include acneiform eruptions due to medications (L27.0) and other skin disorders.
  • Alternative codes for exclusions may include L71 for rosacea.
  • Common exclusion errors involve misdiagnosing rosacea as acne; ensure accurate clinical assessment.
  • Certain conditions are excluded due to differing pathophysiology and treatment approaches.

Related ICD-10 Codes

Primary Codes
L70.0
Comedonal acne
L70.1
Inflammatory acne
L70.5
Acne vulgaris, unspecified
Ancillary Codes
Z79.3
Differential Codes
L73.0
L27.0

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Dermatology

Specialty Applications

  • This diagnosis applies to individuals with acne vulgaris, including adolescents and adults.
  • Appropriate in clinical scenarios involving treatment initiation or monitoring.
  • Applicable in outpatient settings; inpatient use is rare unless complications arise.
  • Dermatology is the primary specialty, but primary care providers may also use this code.

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 vulgaris diagnosed based on clinical findings of comedones and pustules.'

Template 2

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

Template 3

Template: 'Diagnostic criteria met: presence of papules and pustules on the face.'

Template 4

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

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, and treatment history.

When should this code be used vs similar codes?

Use this code for acne vulgaris; consider L71 for rosacea or L70.2 for acne conglobata.

What are common billing issues with this code?

Reimbursement may be denied if documentation does not support medical necessity.

What procedures are commonly associated?

Related CPT codes include 96900 for photodynamic therapy and 11100 for skin biopsy.