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Commonly Coded Conditions in Dermatology
Commonly Coded Conditions in
Dermatology
Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD Director, ICD-10 Development and Training AAPC Commonly Coded Conditions in Dermatology
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Commonly Coded Conditions in Dermatology
- Dermatitis
- Actinic and seborrheic keratosis
- Acne
- Ulcers
- Psoriasis
AGENDA
Commonly Coded Conditions in Dermatology
Commonly Coded Conditions in Dermatology
- 7 - year-old girl brought in for itchy, popular rash on the flexural surfaces of the neck, axillae, and elbows. No other family members with AD, but mother has asthma. Scratching of the lesions is worse at night. Patient with lichenification in left elbow area. Patient is diagnosed with flexural dermatitis. L20.82 Flexural eczema Z82.5 Family history of asthma and other chronic lower respiratory diseases
Example
Commonly Coded Conditions in Dermatology
- Located in category L L21.0 Seborrheic capitis L21.1 Seborrheic infantile L21.8 Other seborrheic dermatitis L21.9 Seborrheic dermatitis, unspecified
Seborrheic dermatitis
Commonly Coded Conditions in Dermatology
- A new mother brings her infant in because she is worried about a yellowish, crusty deposit on the baby’s scalp. He is diagnosed with cradle cap. The mother is told to wash the baby’s hair once a day with a mild baby shampoo and brush gently with a soft brush to loosen the scales. L21.0 Seborrhea capitis
Example
Commonly Coded Conditions in Dermatology
- Contact dermatitis is classified as:
- Allergic contact dermatitis (ACD)
- Occurs when a particular substance elicits a hypersensitive reaction within hours or days
- Irritant contact dermatitis (ICD)
- Occurs when a particular substance that can cause an eruption in most people who come in contact with it elicits an inflammatory reaction within minutes or hours
Contact dermatitis
Commonly Coded Conditions in Dermatology
- Linda presents with two months of severe itching, redness, and scaling on her eyelids. She has tried aloe vera without relief. On exam, she has bilateral symmetric, pruritic, erythematous, scaly plaques on her upper eyelids. Upon further questioning, she admits to a recent change in her brand of eye shadow. She is diagnosed with allergic contact dermatitis due to her eye shadow. She is told to discontinue use of the eye shadow and is given a prescription for desonide cream to apply twice a day for 1 week, the once a day for 1- 2 weeks. L23.2 Allergic contact dermatitis due to cosmetics H01.111 Allergic dermatitis of right upper eyelid H01.114 Allergic dermatitis of left upper eyelid
Example
Commonly Coded Conditions in Dermatology
- L23 Allergic contact dermatitis Excludes2: dermatitis due to substances taken internally dermatitis of eyelid diaper dermatitis eczema of external ear irritant contact dermatitis perioral dermatitis radiation-related disorders of the skin and subcutaneous tissue
Commonly Coded Conditions in Dermatology
- Jack presents with itching, red, and cracking hands. He is a concrete worker. He states sometimes his hands blister and bleed. He states that they get better when he goes on vacation. He is diagnosed with irritant contact dermatitis due to continuous cement exposure. L24.5 Irritant contact dermatitis due to other chemical products
Example
Commonly Coded Conditions in Dermatology
- The ICD- 10 - CM code for actinic keratosis (AK) is L57.
- The ICD- 10 - CM codes for seborrheic keratosis (SK) are L82.0 Inflamed seborrheic keratosis L82.1 Other seborrheic keratosis
Actinic and seborrheic keratosis
Commonly Coded Conditions in Dermatology
- Three factors contribute to acne: - Overproduction of sebum - Irregular shedding of dead skin cells - Build up of bacteria
Acne
Commonly Coded Conditions in Dermatology
- Most codes are located in category L L70.0 Acne vulgaris L70.1 Acne conglobata L70.2 Acne varioliformis L70.3 Acne tropica L70.4 Infantile acne L70.5 Acne excoriee des jeunes filles L70.8 Other acne L70.9 Acne, unspecified
Acne
Commonly Coded Conditions in Dermatology
- Acne vulgaris – A chronic acne involving mainly the face, chest, and shoulders common in adolescents
Types of Acne
Commonly Coded Conditions in Dermatology
- 16 - year-old Jason presents for treatment of his acne vulgaris. Both sides of his face are affected with moderate acne, consisting of comedones, papules, and pustules. He is beginning Retin-A and benzoyl peroxide as topical treatments. Discussed with patient and his mother that significant improvement may take 2 to 3 months. He is to use benzoyl peroxide in the morning and Retin-A in the evening. Also discussed that skin may redden and peel at first, but this will diminish with continued use. All questions answered. L70.0 Acne vulgaris
Example
Commonly Coded Conditions in Dermatology
- Acne varioliformis – A pyogenic infection of the hair follicles occurring chiefly on the forehead and temples
Types of Acne
Commonly Coded Conditions in Dermatology
- A 35-year-old man presents with complaints of an eruption around the border of his scalp and forehead for seven months. Upon examination, there are necrotic lesions going back into the scalp. The patient is diagnosed with acne varioliformis and prescribed tetracycline and topical clindamycin. L70.2 Acne varioliformis
Example
Commonly Coded Conditions in Dermatology
- Pat came in to the clinic complaining of multiple blackheads and whiteheads on his back, buttocks, and arms. He just got back from a trip from South America. He said the heat was unbearable and he had to spend a lot of time outdoors. He is diagnosed with acne tropica and was prescribed topical retinoid and an antibiotic. L70.3 Acne tropica
Example
Commonly Coded Conditions in Dermatology
- Coding for pressure ulcers
- Site
- Laterality
- Severity by stage
- Combination codes in ICD- 10 - CM
Pressure Ulcers
Commonly Coded Conditions in Dermatology The stage II ulcer is an open wound:
- The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
- The pressure ulcer may appear as a shallow, pinkish-red, basin-like wound.
- It may also appear as an intact or ruptured fluid-filled blister.
Stage II
Commonly Coded Conditions in Dermatology At this stage, the ulcer is a deep wound:
- The loss of skin usually exposes some amount of fat.
- The ulcer has a crater-like appearance.
- The bottom of the wound may have some yellowish dead tissue (slough).
- The damage may extend beyond the primary wound below layers of healthy skin.
Stage III
Commonly Coded Conditions in Dermatology A stage IV ulcer exhibits large-scale loss of tissue:
- The wound may expose muscle, bone, and tendons.
- The bottom of the wound likely contains slough or dark, crusty dead tissue (eschar).
- The damage often extends beyond the primary wound below layers of healthy skin.
Stage IV
Commonly Coded Conditions in Dermatology
- Patient is 72 and has recently been admitted to the hospital. She complains of pain in her left buttock. It hurts when she sits down, so she has been shifting her weight to her right side to stop the pain, but this is causing stiffness. On examination, there is an oval area of broken skin, with dermal and epidermal skin loss, about 1 cm in diameter, indicating a Stage 2 pressure ulcer. L89.322 Pressure ulcer of left buttock, stage 2
Example
Commonly Coded Conditions in Dermatology Severity
- Limited to breakdown of skin
- With fat layer exposed
- With necrosis of muscle
- With necrosis of bone
Non-Pressure Ulcers
Commonly Coded Conditions in Dermatology
- There are also instructional notes for the codes that state to code first and associated underlying conditions, such as: Any associated gangrene (I96) Atherosclerosis of the lower extremities (I70.23-, I70.24-, I70.33-, I70.34- , I70.43-, I70.44-, I70.53-, I70.54-, I70.63-, I70.64-, I70.73-, I70.74-) Chronic venous hypertension (I87.31-, I87.33-) „Diabetic ulcers (E08.621, E08.622, E09.621, E09.622, E10.621, E10.622, E11.621, E11.622,E13.621, E13.622) Postphlebitic syndrome (I87.01-, I87.03-) Postthrombotic syndrome (I87.01-, I87.03-) Varicose ulcer (I83.0-, I83.2-)
Non-Pressure Chronic Ulcers
Commonly Coded Conditions in Dermatology
- Patient is a type 2 diabetic who presents with a type 2 diabetic left midfoot ulcer open into the dermis, but not full-thickness. E11.621 Type 2 diabetes mellitus with foot ulcer L97.421 Non-pressure chronic ulcer of left heel and midfoot limited to breakdown of skin
Example
Commonly Coded Conditions in Dermatology
- Patient seen for venous stasis ulcer of right calf with the fat layer exposed. I83.012 Varicose veins of right lower extremity with ulcer of calf L97.212 Non-pressure chronic ulcer of right calf with fat layer exposed
Example
