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ICD-10 Guide
ICD-10 CodesL02.231

L02.231

Billable

Carbuncle of abdominal wall

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

Code Description

ICD-10 L02.231 is a billable code used to indicate a diagnosis of carbuncle of abdominal wall.

Key Diagnostic Point:

A carbuncle of the abdominal wall is a painful, pus-filled bump that arises from a bacterial infection of the hair follicles in the skin. It typically presents as a cluster of interconnected boils, often accompanied by redness, swelling, and tenderness in the affected area. The abdominal wall, being a common site for such infections, can be affected due to factors such as friction, poor hygiene, or underlying health conditions that compromise the immune system. The disease progression can vary; it may start as a small, red bump that gradually enlarges and becomes filled with pus. In some cases, systemic symptoms such as fever may occur if the infection spreads. Diagnosis is primarily clinical, based on the appearance of the lesion and patient history. Laboratory tests may be performed to identify the causative organism, particularly if the carbuncle is recurrent or does not respond to initial treatment. Differential diagnoses include other skin infections like abscesses or folliculitis, making accurate diagnosis crucial for effective management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and sometimes laboratory confirmation.
  • Treatment complexity: May involve incision and drainage, antibiotics, and management of underlying conditions.
  • Documentation requirements: Detailed documentation of clinical findings, treatment plans, and follow-up care is essential.
  • Coding specificity: Requires precise coding to differentiate from other skin infections.

Audit Risk Factors

  • Common coding errors: Misclassification with other skin infections.
  • Documentation gaps: Incomplete records regarding the extent of the infection.
  • Billing challenges: Potential denials due to lack of supporting documentation for the diagnosis.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: General Surgery

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

Carbuncles, including those on the abdominal wall, can significantly affect patient quality of life due to pain and discomfort. They may lead to increased healthcare utilization, including outpatient visits and potential surgical interventions. Understanding the epidemiology of skin infections, particularly in populations with higher risk factors such as diabetes or immunocompromised states, is crucial for public health initiatives aimed at prevention and early treatment.

ICD-9 vs ICD-10

Carbuncles, including those on the abdominal wall, can significantly affect patient quality of life due to pain and discomfort. They may lead to increased healthcare utilization, including outpatient visits and potential surgical interventions. Understanding the epidemiology of skin infections, particularly in populations with higher risk factors such as diabetes or immunocompromised states, is crucial for public health initiatives aimed at prevention and early treatment.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure performed, such as incision and drainage, and whether the patient requires follow-up care. Common denials may occur if documentation does not clearly support the diagnosis or if the procedure is not adequately justified. Best practices include thorough documentation of the patient's history, the clinical examination, and the rationale for the treatment plan to minimize audit risks and ensure appropriate reimbursement.

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 L02.231?

L02.231 specifically covers carbuncles located on the abdominal wall, which are characterized by multiple interconnected boils resulting from bacterial infections, primarily Staphylococcus aureus.

When should L02.231 be used instead of related codes?

L02.231 should be used when the carbuncle is specifically located on the abdominal wall, distinguishing it from carbuncles in other locations such as the trunk or extremities, which have different codes.

What documentation supports L02.231?

Documentation should include clinical findings such as the size, number, and appearance of the carbuncle, any systemic symptoms, treatment provided, and follow-up care. Photographic evidence may also be beneficial.