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ICD-10 Guide
ICD-10 CodesChapter 12: Diseases of the skin and subcutaneous tissueL05

L05

Non-billable

Pilonidal cyst and sinus

Chapter 12:Diseases of the skin and subcutaneous tissue

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

Code Description

ICD-10 L05 is a used to indicate a diagnosis of pilonidal cyst and sinus.

Key Diagnostic Point:

The ICD-10 Level 1 Category code L05 refers to pilonidal cysts and sinuses, which are abnormal pockets of tissue that can form in the skin, typically located at the top of the buttocks near the tailbone. These cysts may contain hair, skin debris, and other substances. Pilonidal disease can lead to discomfort, pain, and infection, and is more common in young adults, particularly males. The clinical significance of this condition lies in its potential to cause recurrent infections and complications if not properly managed. Treatment often involves surgical intervention to remove the cyst and prevent recurrence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation
  • Surgical management options
  • Potential for recurrence

Audit Risk Factors

  • Inadequate documentation of symptoms
  • Misclassification of acute vs. chronic conditions
  • Failure to document previous treatments or surgeries

Specialty Focus

Medical Specialties

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

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

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

The clinical impact of L05 is significant, as pilonidal disease can affect a patient's quality of life and may require repeated interventions. From an administrative perspective, accurate coding and billing for this condition are crucial for tracking treatment outcomes and resource utilization. Additionally, understanding the epidemiology of pilonidal disease can inform public health strategies aimed at prevention and management, especially in populations at higher risk.

ICD-9 vs ICD-10

The clinical impact of L05 is significant, as pilonidal disease can affect a patient's quality of life and may require repeated interventions. From an administrative perspective, accurate coding and billing for this condition are crucial for tracking treatment outcomes and resource utilization. Additionally, understanding the epidemiology of pilonidal disease can inform public health strategies aimed at prevention and management, especially in populations at higher risk.

Reimbursement & Billing Impact

billing for this condition are crucial for tracking treatment outcomes and resource utilization. Additionally, understanding the epidemiology of pilonidal disease can inform public health strategies aimed at prevention and management, especially in populations at higher risk.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for L05

Coding & Billing References

  • •
    Official ICD-10 Guidelines for L05

Frequently Asked Questions

What conditions are included in L05?

L05 encompasses pilonidal cysts and sinuses, which may present as acute or chronic conditions, and can lead to complications such as abscess formation.

When should I use L05 codes?

L05 codes should be used when diagnosing pilonidal cysts or sinuses, particularly when surgical intervention is planned or when the condition is causing significant symptoms.

What documentation is required for L05?

Documentation should include a detailed description of the cyst or sinus, symptoms experienced by the patient, any previous treatments, and the rationale for surgical intervention if applicable.