Nail fungus, or Onychomycosis, is a common disease that affects a significant number of people all over the world.
In healthcare billing, accurate diagnosis codes are key. For example, ICD-10 toenail fungus helps with documentation, treatment, and insurance reimbursement.
A standard code is B35.1. It stands for tinea unguium, a medical term for a fungal nail infection.
At Health Med Affairs, we focus on medical billing and coding. We serve dermatologists, podiatrists, and general physicians throughout Texas. We aim to use the ICD-10 code for Onychomycosis correctly. It will help reduce claim denials and boost revenue.
Below, we cover everything from Onychomycosis to how it’s diagnosed, treated, and properly coded using ICD-10 standards.
What Is Onychomycosis?
Onychomycosis is a nail infection caused by fungi, yeast, or spores. It affects the nail’s appearance.
These are more likely to influence the toenails because they are often moist and dark in conditions that promote the growth of fungi.
The Importance of Accurate Coding
Precise diagnosis and coding are essential for:
- Processing insurance claims and reimbursements
- Maintaining clear medical documentation
- Planning effective treatment
- Reporting clinical data
At Health Med Affairs, we make sure every detail counts. Our certified coders and billing experts align your documentation with accurate ICD-10 usage.
ICD-10 Code for Onychomycosis
The definite code in nail fungus ICD-10 is:
ICD-10: B35.1 Tinea Unguium (Onychomycosis)
This code records fungal nail infection due to dermatophyte, mold, or yeast infection. It is also called the DX code of Onychomycosis and is essential in the classification of nail fungus ICD 10, especially in dermatology and podiatry billing.
When to Use the ICD-10 Code for Tinea Unguium
Use ICD 10 code for tinea unguium B35.1 when a patient shows clinical signs of nail fungus and the infection is confirmed through:
- Physical examination
- KOH (potassium hydroxide) test
- Fungal culture or biopsy
In case of comorbidities (diabetes, in the given example), do not forget to apply other supplemental codes (e.g., E11.9) to portray the complete clinical image.
Symptoms to Document for Onychomycosis
To justify using Onychomycosis ICD-10, providers should document:
- Nail thickening
- Discoloration (yellow, brown, or white)
- Foul odor
- Pain or discomfort
- Crumbly or brittle nails
- Separation of nail from nail bed (onycholysis)
Our team at Health Med Affairs helps ensure documentation is complete and coding is compliant.
Causes and Risk Factors
The need for ICD-10 toenail fungus codes often arises from infections caused by:
- Exposure to wet, shared places of the body (locker rooms, pools)
- Prolonged wearing of closed-toe shoes
- Over-sweating of the feet
- Unhealthy foot care
- Weakened immune system
- Diabetes
- Improper flow of blood
- Growing age
Older adults and individuals with chronic diseases are more likely to develop this condition.
Types of Onychomycosis
The ICD-10 for Onychomycosis is used across several clinical types:
- Distal Subungual Onychomycosis
The usual format impacts the underside of the nails and the nail foundation.
- White Superficial Onychomycosis
This infection targets the top surface of the nail.
- Proximal Subungual Onychomycosis
It commences at the nail foundation and is frequent among immunocompromised patients.
- Candidal Onychomycosis
This type usually affects fingernails and is caused by Candida species.
Diagnosis: Confirming Fungal Nail Infections
Proper diagnosis is crucial before assigning ICD-10 toenail fungus codes:
- Patient history
- Visual nail examination
- Diagnostic tests such as:
- KOH smear
- Fungal culture
- Nail biopsy (if needed)
Right identification ensures correct ICD-10 coding and proper treatment planning.
Treatment Options for Onychomycosis
Depending on severity, the treatment is:
- Topical Antifungal Treatments
Best for mild to moderate cases. Requires consistent use for several months.
- Oral Antifungal Medications
More effective for severe infections. Requires liver function monitoring due to potential side effects.
- Laser Therapy
Newer treatments involve light to destroy fungus without affecting healthy tissue.
- Surgical Nail Removal
In rare cases, when infection is unresponsive, the nail may be removed to allow direct treatment.
Coding Tips for Healthcare Providers
- To ensure proper billing and claims processing:
- Always record which nails are affected (finger or toe, left or right).
- Use B35.1 as the primary code for confirmed nail fungus.
- Link additional relevant codes when needed, like E11.9 for diabetes without complications.
- Avoid unspecified codes if the diagnosis is precise.
- Ensure documentation supports the diagnosis and service level.
Health Med Affairs simplifies this process, reducing administrative stress on your team.
ICD-10 B35.1 and Other Related Codes
| Code | Description |
| B35.1 | Onychomycosis (nail fungus) |
| B35.0 | Tinea barbae and tinea capitis (scalp/beard) |
| B35.3 | Tinea pedis (athlete’s foot) |
| B35.4 | Ringworm of the body (tinea corporis) |
| B35.5 | Tinea imbricata |
| B35.6 | Jock itch (tinea cruris) |
Assign multiple codes if the patient has multiple fungal infections.
Differentiating Onychomycosis from Other Nail Conditions
Various nail conditions can seem like fungal infections. Conditions to consider before assigning B35.1 include:
- Psoriasis of the nails
- Nail trauma
- Eczema
- Lichen planus
- Subungual melanoma (nail cancer, cancer of the skin)
Making a proper diagnosis to avoid misclassification and wrong treatment is essential.
Importance of Accurate Coding in Revenue Cycle Management (RCM)
Valid use of ICD-10 codes, including B35.1, enhances the complete revenue cycle:
- Prevents claim rejections
- Ensures timely reimbursements
- Fulfills payer documentation requirements
- Improves tracking of quality care metrics
As a trusted medical billing company in Texas, Health Med Affairs helps you achieve consistent revenue through expert coding and RCM solutions.
Mistakes to Avoid with Onychomycosis ICD-10 Coding
Incorrect usage of the ICD-10 code for Onychomycosis may result in:
- Rejected claims
- Underpayments
- Non-compliance with payer policies
Health Med Affairs helps avoid:
- Using B35.1 without lab confirmation
- Confusing skin conditions with nail fungus
- Unspecified coding
- Misuse of ICD-10 jock itch instead of toenail codes
Conclusion
Accurate use of the ICD-10 Code for Onychomycosis, specifically B35.1, is essential in managing fungal nail infections, ensuring timely payments, and maintaining clean claim submissions.
At Health Med Affairs, we understand the complexity of dermatology and podiatry billing.
Whether tinea cruris ICD 10 or nail fungus ICD 10, we ensure your coding is compliant and your documentation supports your claims.
Let Us Help You Code It Right
We assist dermatologists, podiatrists, and general practitioners with precise ICD-10 coding and claims submission.
Don’t let inaccurate Onychomycosis toenail ICD-10 entries cost your practice.
Our services cover Houston, Austin, and Corpus Christi. Contact us today, our coding experts are here to support your growth.
FAQs
Q: What is the ICD-10 code of nail fungus?
B35.1, Tinea Unguium, is the ICD-10 code for recording fungal infection of nails.
Q: Is the confirmation of Onychomycosis required before B35.1?
Yes, confirmation through KOH test, fungal culture, or biopsy is necessary to assign B35.1 correctly.
Q: Is it possible to employ B35.1 when there is a coexistence of diabetes among the patient?
Yes, however, you must also include a code of diabetes diagnosis, e.g., E11.9, as this will reflect the full clinical image.
Q: What will occur if I use a different code that was not specified, instead of the code B35.1?
Applying unidentified codes may cause claim denials or delayed reimbursements. Proper coding increases approval of claims.
Q: What can Health Med Affairs do to assist in the code of Onychomycosis?
We help dermatology and podiatry practices with accurate ICD-10 coding and billing for Onychomycosis.
