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ICD-10 Guide
ICD-10 CodesB36.1

B36.1

Tinea unguium

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 B36.1 is a billable code used to indicate a diagnosis of tinea unguium.

Key Diagnostic Point:

Tinea unguium, also known as onychomycosis, is a fungal infection that affects the nails, particularly the toenails. It is characterized by nail discoloration, thickening, and potential separation from the nail bed. The condition is primarily caused by dermatophytes, although non-dermatophyte molds and yeasts can also be responsible. Tinea unguium is more prevalent in individuals with compromised immune systems, diabetes, or peripheral vascular disease. Symptoms may include nail brittleness, crumbling, and a foul odor. Diagnosis is typically made through clinical examination and confirmed by laboratory tests such as nail clippings or scrapings analyzed via culture or microscopy. Treatment options include topical antifungal agents like ciclopirox and systemic antifungals such as terbinafine or itraconazole, which are often necessary for more severe cases. The management of tinea unguium can be challenging, particularly in immunocompromised patients, as they may experience more severe infections and complications. Regular follow-up and monitoring are essential to ensure treatment efficacy and to prevent recurrence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of fungal infections
  • Identifying the severity of the infection
  • Documenting comorbid conditions that may affect treatment
  • Understanding the various treatment options and their implications

Audit Risk Factors

  • Inadequate documentation of the clinical presentation
  • Failure to specify the site of infection (e.g., toenails vs. fingernails)
  • Lack of evidence for antifungal treatment prescribed
  • Not documenting comorbidities that may complicate the infection

Specialty Focus

Medical Specialties

Dermatology

Documentation Requirements

Detailed clinical notes on nail appearance, symptoms, and treatment response.

Common Clinical Scenarios

Patients presenting with nail discoloration, thickening, or pain.

Billing Considerations

Consideration of patient history, including previous treatments and comorbidities.

Podiatry

Documentation Requirements

Foot examination findings, including nail health and any associated foot conditions.

Common Clinical Scenarios

Patients with diabetes or peripheral vascular disease presenting with nail issues.

Billing Considerations

Importance of assessing vascular status and potential complications.

Coding Guidelines

Inclusion Criteria

Use B36.1 When
  • 10 guidelines specify that B36
  • 1 should be used when the diagnosis of tinea unguium is confirmed
  • It is important to document the site of infection and any relevant comorbidities

Exclusion Criteria

Do NOT use B36.1 When
  • Exclusions include other types of nail infections that are not fungal in nature

Related CPT Codes

11720CPT Code

Debridement of nails

Clinical Scenario

Used when significant nail dystrophy is present.

Documentation Requirements

Document the extent of debridement and the condition of the nails.

Specialty Considerations

Podiatrists may perform this procedure more frequently in diabetic patients.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fungal infections, improving the accuracy of diagnoses and treatment plans. B36.1 provides a clear distinction for tinea unguium, facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fungal infections, improving the accuracy of diagnoses and treatment plans. B36.1 provides a clear distinction for tinea unguium, facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fungal infections, improving the accuracy of diagnoses and treatment plans. B36.1 provides a clear distinction for tinea unguium, facilitating better patient management.

Resources

Clinical References

  • •
    CDC Fungal Diseases

Coding & Billing References

  • •
    CDC Fungal Diseases

Frequently Asked Questions

What are the common treatments for tinea unguium?

Common treatments include topical antifungals like ciclopirox and systemic antifungals such as terbinafine and itraconazole, depending on the severity of the infection.