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ICD-10 Guide
ICD-10 CodesL02.435

L02.435

Billable

Carbuncle of right lower limb

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

Code Description

ICD-10 L02.435 is a billable code used to indicate a diagnosis of carbuncle of right lower limb.

Key Diagnostic Point:

A carbuncle is a cluster of interconnected furuncles (boils) that typically occurs in the skin and subcutaneous tissue, often resulting from bacterial infection, most commonly Staphylococcus aureus. The clinical presentation of a carbuncle includes painful, swollen lumps filled with pus, which may drain spontaneously or require incision and drainage. In the case of L02.435, the carbuncle is specifically located on the right lower limb, which includes the thigh, calf, and foot. The disease progression can lead to systemic symptoms such as fever and malaise if the infection spreads. Diagnostic considerations include a thorough clinical examination, history of the lesion, and, if necessary, laboratory tests to identify the causative organism. Treatment typically involves antibiotics and may require surgical intervention to drain the abscess. Proper management is crucial to prevent complications such as cellulitis or sepsis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and possibly laboratory confirmation.
  • Treatment complexity: May involve both medical and surgical management.
  • Documentation requirements: Detailed documentation of clinical findings and treatment plans is necessary.
  • Coding specificity: Requires accurate coding to specify the location and type of lesion.

Audit Risk Factors

  • Common coding errors: Misidentification of the lesion type or location.
  • Documentation gaps: Incomplete records regarding the extent of the infection or treatment provided.
  • Billing challenges: Potential denials if the documentation does not support the severity or necessity of treatment.

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: Infectious Disease

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Carbuncles, while often localized, can have significant clinical implications if left untreated, potentially leading to systemic infections. Understanding the epidemiology of carbuncles, particularly in populations with higher risks such as diabetics or immunocompromised individuals, is crucial for public health. Effective management can reduce healthcare utilization and improve patient outcomes, emphasizing the importance of accurate coding and documentation.

ICD-9 vs ICD-10

Carbuncles, while often localized, can have significant clinical implications if left untreated, potentially leading to systemic infections. Understanding the epidemiology of carbuncles, particularly in populations with higher risks such as diabetics or immunocompromised individuals, is crucial for public health. Effective management can reduce healthcare utilization and improve patient outcomes, emphasizing the importance of accurate coding and documentation.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case and whether surgical intervention was necessary. Common denials may arise from insufficient documentation or incorrect coding. Best practices include thorough documentation of the clinical findings, treatment rationale, and follow-up care to support the medical necessity of the services rendered.

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 L02.435?

L02.435 covers carbuncles specifically located on the right lower limb, which may arise from various factors including poor hygiene, diabetes, or immunocompromised states. It is important to differentiate it from other skin infections such as cellulitis or abscesses.

When should L02.435 be used instead of related codes?

L02.435 should be used when the clinical diagnosis is confirmed as a carbuncle on the right lower limb. If the lesion is on a different limb or is classified as a furuncle or other type of skin infection, the appropriate code should be selected.

What documentation supports L02.435?

Documentation should include a detailed clinical examination note describing the lesion's characteristics, location, size, and any systemic symptoms. Treatment plans, including any surgical interventions or prescribed antibiotics, should also be documented.