Pilonidal cyst without mention of abscess

This code describes a pilonidal cyst, which is a sac-like structure typically found at the top of the natal cleft (buttocks crease), containing hair and skin debris. It represents an uncomplicated pilonidal cyst that is not currently infected or inflamed to the point of forming an abscess.

Use this code when documentation clearly indicates the presence of a pilonidal cyst without any mention of acute infection, purulent drainage, or abscess formation. This is appropriate for initial diagnosis of an asymptomatic or minimally symptomatic pilonidal cyst, or for follow-up of a previously treated cyst that is currently quiescent.

• Do not use this code if the documentation specifies an abscess; instead, select a code for pilonidal cyst with abscess.
• Ensure the physician's documentation explicitly states "without abscess" or implies its absence through descriptions of a non-inflamed or quiescent cyst.
• Consider codes for excision or marsupialization of pilonidal cysts (e.g., CPT 11770-11772) as potential procedural pairings.