ICD-10 L05.01
Billable / Specific CCPilonidal cyst with abscess
About ICD-10-CM L05.01
ICD-10-CM code L05.01 represents Pilonidal cyst with abscess. This is a billable/specific code in the Skin and Subcutaneous Tissue chapter (block L05). The 2026 edition of ICD-10-CM L05.01 became effective on October 1, 2025.
Coding Tips for L05.01
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
L05.01 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under L05.01. Per CMS ICD-10-CM Tabular 2026.
- Pilonidal abscess
- Pilonidal dimple with abscess
- Postanal dimple with abscess
Type 2 Excludes
Not included here, the excluded code is not part of L05.01, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- congenital sacral dimple (Q82.6)
- parasacral dimple (Q82.6)
Inpatient DRG Impact, CC
codes Pilonidal cyst with abscess. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for L05.01
Local Coverage Determinations (LCDs) from CMS MACs that list L05.01 as a covered diagnosis.
Showing top 10 of 36 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing L05.01.
2 Medicare
1 Aetna
CPT Codes Commonly Billed with L05.01
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
Convert L05.01 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| L05.01 | 6850 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To L05.01
Other codes in section L00-L08 (Infections of the skin and subcutaneous tissue).
ICD-10 L05.01, Billing FAQ
Is ICD-10 code L05.01 billable? +
Yes, L05.01 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to L05.01? +
ICD-10 L05.01 includes: Pilonidal abscess; Pilonidal dimple with abscess; Postanal dimple with abscess.
What codes are Type 2 Excludes for L05.01? +
Type 2 Excludes (may be coded together when both conditions exist): congenital sacral dimple (Q82.6); parasacral dimple (Q82.6)
Is L05.01 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with L05.01? +
Procedures frequently paired with L05.01 include: 10060, 10061.
What ICD-9 codes does L05.01 map to? +
Per CMS GEMs, L05.01 maps to ICD-9 codes: 6850. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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