Paronychia is an infection that affects the skin around your fingernails or toenails. It often shows up on the great toe. The infection makes the skin folds around the nail red, swollen, and painful. Paronychia can be acute, meaning it comes on suddenly, or chronic, meaning it lasts for several weeks or more. There are many different causes, from minor injuries to fungal infections.
When a healthcare professional diagnoses paronychia, it’s important to use the correct ICD-10 code. ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) is a system used to classify diseases and health conditions for billing, data analysis, and tracking public health trends.
This article focuses on the specific ICD-10 code for paronychia affecting the right great toe and provides related information useful for healthcare professionals.
Understanding Paronychia of the Right Great Toe
Paronychia is an infection of the skin around your toenail. Let’s take a closer look at what that means.
Anatomy and Physiology of the Nail and Surrounding Tissue
When we talk about your toenail, we’re talking about a few different parts working together: the nail plate (the hard part), the nail bed (the skin underneath), the nail folds (the skin around the sides), and the cuticle. The paronychium is the soft tissue that surrounds the nail, and it’s the star of the show when it comes to paronychia.
If the skin barrier around your nail gets disrupted, that’s when infection can sneak in, particularly if your toenails are hard to manage, learning how to soften toenails might help. Things like stubbing your toe, biting your nails, or getting a bad pedicure can all increase your risk.
Causes and Risk Factors
Paronychia is usually caused by bacteria or fungi, but what if your nail turns green? Staphylococcus aureus is a common bacterial culprit, while Candida albicans is a common fungal cause, especially when the infection sticks around for a while.
Some things can make you more likely to get paronychia, like having diabetes, washing your hands a lot, or being around irritating chemicals.
Symptoms and Diagnosis
If you have paronychia, you’ll probably notice redness, swelling, pain, and maybe even pus around your toenail, not to be confused with dark toenails. Usually, a doctor can diagnose paronychia just by looking at it. But, if it’s a really bad case or doesn’t seem typical, they might need to do some lab tests.
ICD-10-CM Code for Paronychia of the Right Great Toe
When healthcare providers document a diagnosis, they use a special coding system called ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) to classify and code all diagnoses, symptoms, and procedures. Getting the right code is key for billing, tracking health trends, and making sure patient records are accurate.
Specificity in ICD-10-CM Coding
It’s super important to choose the most specific code you can. This makes sure you’re painting an accurate picture of the patient’s condition. With paronychia, knowing whether it’s on the right or left toe is a big deal because that affects which code you pick.
Examining L03.031: Cellulitis of Right Toe
L03.031 is a valid ICD-10-CM code that you can bill for cellulitis of the right toe. Now, cellulitis isn’t exactly the same as paronychia, but because both involve infection and happen in the same area, they’re closely related. This code has been good since October 1, 2024, which is when the 2025 edition rolled out.
In the ICD-10-CM system, you’ll find it hanging out in the L00-L99 section, which covers skin and subcutaneous tissue diseases. More specifically, it’s part of the L03 group (cellulitis and acute lymphangitis).
Alternative and Related Codes
Keep in mind that there might be other ICD-10 codes that fit the situation better. If the documentation doesn’t say whether it’s the right or left toe, or if the specific condition isn’t clear, you might have to use a more general code for unspecified toe infections.
Also, it’s worth noting that intentionally using a code that’s more (upcoding) or less (downcoding) specific than the patient’s actual condition raises some ethical questions. Accuracy and honesty are always the best policy!
Clinical Application and Reimbursement
Coding accurately is essential to getting fairly reimbursed for treating paronychia. Here’s what you need to know.
Documentation requirements
Your documentation needs to be clear, complete, and accurate. It’s important to include all the relevant details in your medical record to support your ICD-10 code and show why the treatment was medically necessary.
Always specify whether the paronychia is on the right or left side and which toe is affected.
Billing and reimbursement considerations
Accurate coding directly affects how much you get paid. If you code incorrectly, your claims could be denied or delayed. The correct code helps connect your services to a Diagnostic Related Group (MS-DRG), such as L03.031.
Synonyms and related terms
Here are a few approximate synonyms for paronychia of the right great toe:
- Infected nail right big toe
- Abscess around nail right big toe
- Inflammation nail fold right big toe
Sometimes, it can be confusing to understand the relationships between onychia, paronychia, and perionychia. They all involve the nail. Onychia is inflammation of the nail matrix itself. Paronychia is an infection of the skin around the nail. Perionychia is another term for paronychia.
Frequently Asked Questions
What is the CPT code for paronychia of the great toe?
CPT (Current Procedural Terminology) codes depend on the treatment performed. For incision and drainage of a paronychia, common codes include 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) or 10061 (…complicated or multiple). Always consult the CPT manual for the most accurate code based on the specific procedure.
Can you get paronychia on toes?
Absolutely! While paronychia is more common on fingers, it can definitely occur on toes, including the great toe. It’s an infection of the skin around the nail, often caused by bacteria or fungi entering through a break in the skin.
What is the ICD-10 code for right great toe nail?
This is a bit broad as it depends what is wrong with the toenail. If you’re looking for paronychia of the right great toe, a common and appropriate ICD-10 code is L03.031 (Cellulitis of right toe). However, the precise code will depend on the specific diagnosis and any associated conditions.
What is the code for acute paronychia?
As stated above, a common and appropriate ICD-10 code is L03.0 (Cellulitis of finger and toe). Further specificity would be added to denote which toe is infected. Acute paronychia means it’s a sudden onset infection.
What is the ICD-9 code for paronychia of the big toe?
ICD-9 codes are outdated. We now use ICD-10. However, for historical reference, the ICD-9 code for paronychia (general, not specifically the big toe) was 686.1. Keep in mind that ICD-10 is the current standard for medical coding.
Wrapping Up
The ICD-10 code for paronychia of the right great toe is L03.011. Accurate coding is essential for getting the right diagnosis, treatment, and reimbursement. Coding guidelines and codes change from time to time, so it’s important to stay up-to-date on the latest information.