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v1.0.0
ICD-10 Guide
ICD-10 CodesL74.0

L74.0

Billable

Miliaria rubra

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

Code Description

ICD-10 L74.0 is a billable code used to indicate a diagnosis of miliaria rubra.

Key Diagnostic Point:

Miliaria rubra, commonly known as heat rash or prickly heat, is a dermatological condition characterized by the obstruction of sweat ducts, leading to the accumulation of sweat beneath the skin. Clinically, it presents as small, red, itchy papules or vesicles, often accompanied by a burning sensation. The condition typically occurs in hot, humid environments, particularly in individuals who sweat excessively or wear tight clothing. The anatomy involved includes the epidermis and the sweat glands, particularly the eccrine glands, which are responsible for thermoregulation. Disease progression can vary; while mild cases may resolve spontaneously with cooling measures, more severe cases can lead to secondary infections if not managed properly. Diagnostic considerations include a thorough clinical examination and patient history to differentiate miliaria rubra from other skin conditions such as folliculitis or contact dermatitis. Treatment primarily focuses on alleviating symptoms through cooling the skin, wearing loose clothing, and avoiding excessive heat exposure.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low - primarily clinical diagnosis based on presentation
  • Treatment complexity: Low - involves basic symptomatic management
  • Documentation requirements: Low - straightforward documentation needed
  • Coding specificity: Medium - specific to miliaria rubra but related codes exist

Audit Risk Factors

  • Common coding errors: Misclassification with other skin conditions
  • Documentation gaps: Incomplete patient history or symptom description
  • Billing challenges: Potential denials due to lack of specificity in documentation

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

Primary Care

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

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CPT Code

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ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Miliaria rubra has significant clinical implications, particularly in populations exposed to high temperatures, such as athletes or outdoor workers. Understanding this condition can improve patient care by promoting preventive measures and effective management strategies. Epidemiologically, it is more prevalent in humid climates and can lead to increased healthcare utilization during summer months, highlighting the need for awareness and education among healthcare providers.

ICD-9 vs ICD-10

Miliaria rubra has significant clinical implications, particularly in populations exposed to high temperatures, such as athletes or outdoor workers. Understanding this condition can improve patient care by promoting preventive measures and effective management strategies. Epidemiologically, it is more prevalent in humid climates and can lead to increased healthcare utilization during summer months, highlighting the need for awareness and education among healthcare providers.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the condition is well-documented in the patient’s medical record, particularly the history of heat exposure and symptomatology. Common denials may arise from insufficient documentation or misclassification of the condition. Best practices include using specific codes that accurately reflect the diagnosis and maintaining clear communication with payers regarding the nature of the condition and treatment provided.

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 L74.0?

L74.0 specifically covers miliaria rubra, which is characterized by red, itchy papules due to blocked sweat glands. It does not include other forms of miliaria, such as miliaria crystallina (L74.1) or miliaria profunda (L74.2).

When should L74.0 be used instead of related codes?

L74.0 should be used when the clinical presentation is consistent with miliaria rubra, particularly when the rash is red and itchy, and there is a clear history of heat exposure. If the rash is clear and vesicular, L74.1 may be more appropriate.

What documentation supports L74.0?

Documentation should include a detailed patient history, physical examination findings, and any relevant environmental factors contributing to the condition. Notes on treatment provided and patient response can also support the use of this code.