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ICD-10 Guide
ICD-10 CodesL56.1

L56.1

Billable

Drug photoallergic response

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

Code Description

ICD-10 L56.1 is a billable code used to indicate a diagnosis of drug photoallergic response.

Key Diagnostic Point:

L56.1 refers to a drug photoallergic response, which is a type of skin reaction triggered by exposure to sunlight after the administration of certain medications. Clinically, patients may present with erythema, pruritus, and vesicular lesions that typically occur in sun-exposed areas of the skin. The pathophysiology involves the formation of a photoreactive compound when the drug interacts with UV radiation, leading to an immune-mediated response. The most commonly implicated drugs include certain antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), and some diuretics. Disease progression can vary; some patients may experience mild symptoms that resolve with avoidance of the triggering drug and sun exposure, while others may develop more severe reactions requiring medical intervention. Diagnostic considerations include a thorough patient history, identification of the offending drug, and possibly a patch test or photopatch test to confirm the diagnosis. It is essential for healthcare providers to differentiate drug photoallergic responses from other photodermatoses to ensure appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful history-taking and sometimes specialized testing.
  • Treatment complexity: Management may involve drug discontinuation and symptomatic treatment.
  • Documentation requirements: Detailed documentation of drug history and clinical findings is necessary.
  • Coding specificity: Requires accurate identification of the specific drug involved.

Audit Risk Factors

  • Common coding errors: Misidentifying the reaction type or failing to specify the drug.
  • Documentation gaps: Incomplete patient history or lack of evidence for drug exposure.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis.

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

Allergy and Immunology

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

The clinical significance of drug photoallergic responses lies in their potential to cause significant discomfort and morbidity for affected individuals. Population health impact is notable, as these reactions can lead to increased healthcare utilization due to the need for dermatological consultations and treatments. Quality measures may include monitoring the incidence of drug-related skin reactions and ensuring appropriate patient education on medication use and sun exposure. Epidemiologically, awareness of these reactions is essential for both healthcare providers and patients to prevent future occurrences.

ICD-9 vs ICD-10

The clinical significance of drug photoallergic responses lies in their potential to cause significant discomfort and morbidity for affected individuals. Population health impact is notable, as these reactions can lead to increased healthcare utilization due to the need for dermatological consultations and treatments. Quality measures may include monitoring the incidence of drug-related skin reactions and ensuring appropriate patient education on medication use and sun exposure. Epidemiologically, awareness of these reactions is essential for both healthcare providers and patients to prevent future occurrences.

Reimbursement & Billing Impact

Reimbursement considerations should also take into account the patient's insurance policy, as some plans may have specific requirements for coverage of dermatological conditions.

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 L56.1?

L56.1 covers drug-induced photoallergic reactions, which can include conditions like photodermatitis triggered by medications such as sulfonamides, tetracyclines, and NSAIDs. The diagnosis is confirmed through clinical evaluation and history of drug exposure.

When should L56.1 be used instead of related codes?

L56.1 should be used specifically when the skin reaction is due to a drug that causes an allergic response upon sun exposure. If the reaction is purely phototoxic without an allergic component, L56.0 would be more appropriate.

What documentation supports L56.1?

Documentation should include a detailed patient history of drug use, description of symptoms, timing of the reaction in relation to drug exposure, and any diagnostic tests performed, such as patch testing.