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ICD-10 Guide
ICD-10 CodesB36.3

B36.3

Tinea unguium

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

Code Description

ICD-10 B36.3 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, primarily the toenails, but can also involve fingernails. It is characterized by nail discoloration, thickening, and potential separation from the nail bed. The condition is often caused by dermatophytes, but non-dermatophyte molds and yeasts can also be responsible. Risk factors include advanced age, diabetes mellitus, immunocompromised states, and poor circulation. Patients may experience discomfort, pain, and cosmetic concerns due to the appearance of the affected nails. Diagnosis is typically made through clinical examination and may be confirmed with laboratory tests such as nail clippings or scrapings sent for fungal culture or microscopy. Treatment options include topical antifungal agents, such as ciclopirox and efinaconazole, and systemic antifungal medications like terbinafine and itraconazole. The choice of treatment often depends on the severity of the infection, the patient's overall health, and any underlying conditions that may affect treatment efficacy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of fungal infections
  • Identifying the severity of the infection
  • Considering patient comorbidities (e.g., diabetes, immunocompromised status)
  • Understanding treatment options and their implications

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document comorbid conditions
  • Incorrect coding of the severity of the infection
  • Lack of evidence for treatment decisions

Specialty Focus

Medical Specialties

Dermatology

Documentation Requirements

Detailed clinical notes on nail examination, treatment plans, and follow-up assessments.

Common Clinical Scenarios

Patients presenting with nail discoloration, thickening, or pain; recurrent infections; and treatment failures.

Billing Considerations

Consideration of patient history, including previous treatments and response, is crucial for accurate coding.

Podiatry

Documentation Requirements

Comprehensive foot examinations, including vascular and neurological assessments, and documentation of any underlying conditions.

Common Clinical Scenarios

Patients with diabetes presenting with nail infections, athletes with fungal infections, and elderly patients with nail dystrophies.

Billing Considerations

Podiatrists must document the impact of the infection on mobility and overall foot health.

Coding Guidelines

Inclusion Criteria

Use B36.3 When
  • According to ICD
  • 10 guidelines, B36
  • 3 should be used when the diagnosis of tinea unguium is confirmed
  • It is essential to document the clinical findings and any relevant patient history

Exclusion Criteria

Do NOT use B36.3 When
  • Exclusion criteria include other nail conditions that are not fungal in nature

Related CPT Codes

11720CPT Code

Debridement of nails

Clinical Scenario

Used when significant nail dystrophy is present and requires removal of infected nail material.

Documentation Requirements

Document the extent of debridement and the condition of the nail bed.

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 tracking. B36.3 provides a clear designation for tinea unguium, facilitating better patient management and research.

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 tracking. B36.3 provides a clear designation for tinea unguium, facilitating better patient management and research.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fungal infections, improving the accuracy of diagnoses and treatment tracking. B36.3 provides a clear designation for tinea unguium, facilitating better patient management and research.

Resources

Clinical References

  • •
    CDC Fungal Diseases

Coding & Billing References

  • •
    CDC Fungal Diseases

Frequently Asked Questions

What is the primary cause of tinea unguium?

Tinea unguium is primarily caused by dermatophyte fungi, but can also be due to non-dermatophyte molds and yeasts.

How is tinea unguium diagnosed?

Diagnosis is made through clinical examination and can be confirmed with laboratory tests such as nail clippings or cultures.

What are the treatment options for tinea unguium?

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