You may not be familiar with what ICD codes are, but you need to know if you hope to get your hair loss treatment covered by your insurance. Finding your ICD 10 CM code may seem daunting, but I’ll try to simplify it for you.
First, you should know what an ICD code is and how to tell which code might be the best one to describe your alopecia.
What Are ICD Codes?
ICD stands for International Classification of Diseases. The ICD system was developed by the World Health Organization (WHO) to help the healthcare system stay as organized as possible.
When needed, these codes are updated as more diseases are learned about and in order to better organize them. These updates are then published, with each country of the WHO determining for itself when it will switch to the new version.
The ICD currently in use as I write this is ICD 10, which was first published in 1992. Since the US also uses these codes to file with their insurance for reimbursement purposes, updating to ICD 10 took until 2015.
ICD 10 CM and PCS refer to the Clinical Modification and Procedure Coding Systems, respectively. Though similar, the CM codes are used for diagnosis, while the PCS is for the treatment you are given.
The ICD 10 Codes For Hair Loss
ICD codes start with three characters that indicate the category of the injury or disease something is placed. The fourth character usually indicates the exact place, with a fifth, sixth, and sometimes seventh character giving more specifics.
For example, a fracture of your forearm is S53. If it is at the lower end of your radius bone, it is S53.5, and if it is a torus fracture, it is S53.52.
Hair loss is in the L00-L99 section, which is for diseases of the skin and subcutaneous tissue. More specifically, most hair disorders are put in L60-L75, which are disorders of skin appendages.
For hair loss caused by alopecia areata, the category is L63. The L63 type of hair loss has the underlying cause of the immune system attacking your scalp, causing you to lose hair as your follicles are damaged.
This has a high chance of causing scaring of your follicles. There are also a few more specific designations as follows:
L63.0 Alopecia (capitis) totalis
This code is for when your alopecia causes all the hair on your scalp to fall out. It also often causes you to lose your eyebrows and eyelashes.
L63.1: Alopecia universalis
Similar to L63.0, this type causes you to lose all your hair. However, Universalis causes this all over your skin, including on your arms, legs, and other areas.
This still involves your immune system attacking your hair, but in a specific crescent shape. This is usually found at or near the hairline at the back of your neck or above your ears.
L63.8: Other alopecia areata
This code is for when your immune system is attacking your hair, but in such a way that it doesn’t fit into one of the other categories.
This is the ICD 10 L64 section, which is where hereditary hair problems are at.
L64.0: Drug-induced Androgenic Alopecia
This code is for general thinning or loss of your hair due to taking a certain medication. For this, doctors are asked to include what medication is causing it.
L64.8: Other Androgenic Alopecia
This code is for types of alopecia that are hereditary. This is where male pattern baldness is put. Though family history does play a role in this hair condition, early treatment can allow you to keep your hair even as you get older.
L64.9: Androgenic Alopecia, Unspecified
This unspecified place is for hair loss that is thought to have a hereditary factor, but which doesn’t fit in L64.0 or L64.8.
Other Non-Scaring Hair Loss
The L65 code is used for types of hair loss that do not usually involve scarring. These types of hair loss are caused by all sorts of things and sometimes require no treatment to make your hairs grow.
L65.0: Telogen Effluvium
Telogen effluvium is where your hair falls out during its telogen phase. Though your hair is resting during the telogen phase, your hairs are supposed to stay in their follicles.
This is most often caused by stress, but certain diseases or having surgery can cause enough stress on your body to cause this as well. Usually, it resolves itself, and your hair grows back on time for the next phase.
L65.1: Anagen EffluVium
This code is for when your hair falls out in what is supposed to be its growth phase. Certain medicines and medical treatments can cause this, such as chemotherapy. Since there is little to no permanent damage, hair restoration is possible.
L65.2: Alopecia Mucinosa
This disease can occur anywhere on the scalp, face, or neck, always causing hair loss when present on the scalp. It is caused by mucinous material building up in your follicles and oil glands, causing inflammation.
Though quick treatment prevents any scarring, in severe cases, the follicles become permanently damaged.
L65.8 Other Nonscarring Hair Loss, Specified
Though not commonly used, this code is for when the cause of hair loss is specified somewhere in the ICD notes but has not been given its own distinct designation.
L65.9 Nonscarring Hair Loss, Unspecified
This code is used when little information is known about a specific condition. Doctors are encouraged to avoid using this code when there is any other one that works.
Cicatricial Alopecia [Scarring Hair Loss]
All the ICD 10 codes in the L66 section cause scarring to your follicles. Little is known about some of these, but most involve some type of swelling and redness. Some of these are similar, looking almost identical but having different causes.
This is a rare scalp disease that spreads in irregular patches of hair loss. Though it is diagnosable, little is known about what causes it.
L66.1: Lichen Planopilaris
Lichen planopilaris is also called scarring alopecia. It can affect the body in places other than the scalp, causing redness, inflammation, and often permanent hair loss. It is thought to be an immune system malfunction.
L66.2: Folliculitis Decalvans
This scalp disease is similar to L66.1, but it also sometimes involves oozing and has a different cause. It can still cause follicle scaring, though, preventing your hair from regrowing. It is thought to be caused by a certain bacteria.
L66.3: Perifolliculitis Capitis Abscedens
This disease is where spots on your scalp feel spongy and swollen, with your hair falling out in those areas. It is a rare and chronic disease that little is known about.
L66.4: Folliculitis Ulerythematosa Reticulata
This code is used when keratosis pilaris (KP), a rare type of skin condition, affects the scalp. It causes acne-like bumps and redness.
L66.8: Other Cicatricial Alopecia
There are other types of conditions that are known to cause scarring alopecia. These are sometimes so rare that they are not given their own designation.
L66.9: Cicatricial Alopecia, Unspecified
This code is for hair loss that seems to be related to scaring, but little is known about it.
What About ICD 11?
In 2021, WHO released another update for their codes that very few people are aware of, which is ICD 11. Though these codes will be available for all countries to start implementing as of January 1, 2022, the US is still not using the new format yet.
Considering it took over 10 years for the US to implement ICD 10, this is not surprising. At this point, the new ICD is set to take effect in 2025. This may be set back to 2027 if there are any delays, such as a CM version being needed.
The Differences Between ICD 10 & ICD 11
There are many differences between these two ICDs, which will be important to know when the changeover happens. Some healthcare providers may start the changeover process soon.
The ICD 10 version had Roman numerals as its different chapters, while the ICD 11 has Arabic. However, in the US, the 10th version was already altered in that way for convenience, so the 11th version will not change anything for the country.
Instead of the 3-character codes, such as L63 for hair loss, they are making it a 4-character code in order to have more sections. This 4th character will be placed at the front and will indicate the chapter number where it is found.
So, if alopecia areata is placed in chapter 4, which is Diseases of the immune system, it will be 4L63 instead of L63.
O’s and I’s
The letters “O” and “I” can often be confused with the numbers “1” and “0”, especially in certain fonts. Also, the lowercase letter “l” is quite similar and easy to mistake.
So, in the new format, those letters will not be used at all. Only the numbers “1” and “0” will be present, so there is no confusion. The uppercase “L” is still used, but never in its lowercase form.
Filing an insurance claim can be stressful, and putting in the wrong ICD code can prevent you from getting the coverage you need. Some insurances consider hair loss to be cosmetic and don’t cover it unless there is some underlying cause.
Hopefully, knowing these ICD 10 codes for hair loss will help you afford the right treatment for your hair.