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v1.0.0
ICD-10 Guide
ICD-10 CodesL02.93

L02.93

Billable

Carbuncle, unspecified

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

Code Description

ICD-10 L02.93 is a billable code used to indicate a diagnosis of carbuncle, unspecified.

Key Diagnostic Point:

A carbuncle is a painful cluster of boils that are connected to each other under the skin, typically caused by bacterial infection, most commonly Staphylococcus aureus. Clinically, carbuncles present as red, swollen lumps on the skin that may drain pus and are often accompanied by systemic symptoms such as fever and malaise. The anatomy involved includes the skin and subcutaneous tissue, particularly in areas prone to friction or moisture, such as the nape of the neck, armpits, and thighs. Disease progression can lead to significant discomfort and complications if left untreated, including the potential for systemic infection. Diagnostic considerations include a thorough clinical examination, patient history, and, if necessary, laboratory tests to identify the causative organism. In some cases, imaging may be required to assess the extent of the infection or to rule out other conditions such as abscesses or deeper tissue infections.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and sometimes laboratory confirmation.
  • Treatment complexity: May involve antibiotics, drainage procedures, and management of complications.
  • Documentation requirements: Detailed clinical notes on symptoms, treatment plans, and follow-up care are necessary.
  • Coding specificity: Requires differentiation from other skin infections and abscesses.

Audit Risk Factors

  • Common coding errors: Misclassification with other skin infections or abscess codes.
  • Documentation gaps: Incomplete records regarding the extent of the infection or treatment provided.
  • Billing challenges: Potential denials if documentation does not support the diagnosis or if the treatment is not adequately justified.

Specialty Focus

Medical Specialties

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

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 can significantly impact patient quality of life due to pain and discomfort, leading to increased healthcare utilization for treatment and management. Understanding the epidemiology of carbuncles, particularly in populations with higher rates of skin infections, can inform public health strategies. Quality measures may include tracking the incidence of carbuncles and related complications, emphasizing the importance of timely diagnosis and effective treatment to reduce morbidity.

ICD-9 vs ICD-10

Carbuncles can significantly impact patient quality of life due to pain and discomfort, leading to increased healthcare utilization for treatment and management. Understanding the epidemiology of carbuncles, particularly in populations with higher rates of skin infections, can inform public health strategies. Quality measures may include tracking the incidence of carbuncles and related complications, emphasizing the importance of timely diagnosis and effective treatment to reduce morbidity.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case, the necessity of procedures such as drainage, and the use of antibiotics. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the treatment provided. Coders should ensure that all relevant clinical notes are included to support the diagnosis and any procedures performed, adhering to payer-specific guidelines to minimize billing challenges.

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 L02.93?

L02.93 covers carbuncles that are not specified by site, which may include multiple interconnected boils that can occur in various locations on the body. It is essential to differentiate this from other skin infections such as furuncles or abscesses.

When should L02.93 be used instead of related codes?

L02.93 should be used when a carbuncle is diagnosed but the specific site is not documented. If the site is known, a more specific code should be selected to ensure accurate representation of the condition.

What documentation supports L02.93?

Documentation should include a detailed clinical assessment of the carbuncle, including its size, location, symptoms, treatment provided, and any laboratory results that confirm the diagnosis.