Basic ICD-10-CM/PCS Coding 2013 Edition

1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 15: Disease of the Skin and Subcutaneous Tissue (L00–L99)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of diseases of the skin and subcutaneous tissue and related procedures?

3. ICD-10-CM Chapter 12, Diseases of the Skin and Subcutaneous Tissue, L00–L99 Chapter 12 includes categories arranged in the following blocks Infections of the skin and subcutaneous tissue Bullous disorders Dermatitis and eczema Papulosquamous disorders Urticaria and erythema Radiation-related disorders of the skin and subcutaneous tissue Disorders of skin appendages Intraoperative and postprocedural complication Other disorders of the skin and subcutaneous tissue

4. ICD-10-CM Chapter 12, Diseases of the Skin and Subcutaneous Tissue, L00–L99 Codes for diseases skin and subcutaneous tissue contain specificity for the site where the condition exists and laterality (right, left, and such) Combination codes are included for decubitus ulcers represent the site, the laterality, and the stage of the ulcer

5. Instructional Notes for Chapter 12 of ICD-10-CM At the state of Chapter 12 of ICD-10-CM, a series of conditions listed under an Excludes2 note identifies conditions in other chapters that may be coded with diseases of the skin and subcutaneous tissue. An “use additional code (B95–B97) to identify infectious agent” follows certain codes.

6. Instructional Notes for Chapter 12 of ICD-10-CM Instructions state “in this block of terms dermatitis and eczema are used synonymously and interchangeably” Under categories for allergic contact and irritant contact dermatitis there are Excludes1 and Excludes2 notes to identify what can and cannot be coded with these codes For conditions that are due to drugs, a “use additional code” for adverse effect, if applicable, to identify drug (T36–T50) with 5th or 6th character of 5

7. Coding Guidelines for Chapter 12 of ICD-10-CM There are chapter-specific guidelines for Chapter 12 that address Pressure ulcer stage codes Unstageable pressure ulcers Documented pressure ulcer stage Patients admitted with pressure ulcer documented as healed Patients admitted with pressure ulcer documented as healing Patients admitted with pressure ulcer evolving into another stage during the admission

8. Coding Diseases in ICD-10-CM Chapter 12 Cellulitis is an acute inflammation of a localized area of superficial tissue Cutaneous or subcutaneous abscess is a localized collection of pus causing fluctuant soft tissue swelling surrounded by erythema Lymphangitis is inflammation of lymph nodes

9. Coding Diseases in ICD-10-CM Chapter 12 Cellulitis and acute lymphangitis codes include the anatomical site and laterality for each condition. An additional code is assigned to identify the organism involved

10. Coding Diseases in ICD-10-CM Chapter 12 Dermatitis and eczema terminology is used synonymously and interchangeably Dermatitis is an inflammation of the skin Classified by cause or clinical type Atopic, seborrheic, diaper dermatitis Allergic contact and irritant contact dermatitis Exfoliative dermatitis Dermatitis due to substance taken internally As well as unspecified contact dermatitis

11. Coding Diseases in ICD-10-CM Chapter 12 Urticaria is the eruption of itchy patches of skin called wheals or a round raised area of skin, also known as hives Erythema is redness of skin due to capillary dilation Stevens-Johnson syndrome is a bullous form of erythema multiforme Toxic epidermal necrolysis is a syndrome in which large portions of skin become intensely erythematous with epidermal necrolysis

12. Coding Diseases in ICD-10-CM Chapter 12 Radiation-related disorders of the skin and subcutaneous tissue include skin conditions or skin damage that are caused by radiation such as solar factors, ultraviolet light and nonionizing radiation Codes for “sunburn” identify first, second and third degree sunburns A “use additional” code appears to add a code from W89 or X32 to identify the source of the ultraviolet radiation Skin damage can be produced by chronic exposure to ultraviolet light radiation, such as, actinic keratosis

13. Coding Diseases in ICD-10-CM Chapter 12 Disorders of skin appendages are skin and nail conditions such as Ingrowing nail, oncolysis, nail dystrophy Alopecia, hair loss, and excessive hair Acne, roseacea, rhinophyma, follicular cysts Epidermal, pilar, trichodermal, and sebaceous cysts Eccrine sweat and apocrine sweat gland disorders Hyperhidrosis

14. Coding Diseases in ICD-10-CM Chapter 12 Pressure (decubitus) ulcer category contain combination codes that identify the site, the laterality as well as the stage of the pressure ulcer. Examples of codes are: L89.132 Pressure ulcer of right lower back, stage 2 L89.314 Pressure ulcer of right buttock, stage 4 Pressure ulcers are caused by tissue hypoxia secondary to pressure induced vascular insufficiency and the site may become secondarily infected with components of the skin and gastrointestinal flora

15. Coding Diseases in ICD-10-CM Chapter 12 The depth of the ulcer is identified by stages 1 through IV according to the National Pressure Ulcer Advisory Panel Stage I: Intact skin with non-blanching erythema Stage II: Abrasion, blister, shallow open ulcer or crater Stage III: Full-thickness skin loss with damage into soft tissue Stage IV: Full-thickness skin loss with damage deeper through soft tissue to the muscle, tendon or tissue around underlying bone Unstageable: Full-thickness tissue loss in which the base of the ulcer is covered by slough and/or eschar in the wound bed or has been treated with a skin or muscle flap

16. Coding Diseases in ICD-10-CM Chapter 12 Non-Pressure Chronic Ulcer of Lower Limb, NEC Defined as a chronic ulcer of the skin of the lower limb as a sole problem or the ulcer may be the result of another condition “Code first any associated underlying condition” such as Atherosclerosis of the lower extremities Chronic venous hypertension Diabetic ulcers Postphlebitic syndrome Postthrombotic syndrome Varicose ulcer Another note states “code first any associated gangrene”

17. Coding Procedures in ICD-10-PCS for Chapter 12 Table 0H0–0HX for the procedures on the skin include the root operations of Change, destruction, division, drainage, Excision, extirpation, extraction, inspection, reattachment, Release, removal, repair, replacement, revision and transfer The same tables are used for procedures that are performed on the breast and include the root operations of Alteration, change, destruction, drainage, excision, extirpation, Insertion, inspection, reattachment, release, removal, repair, Replacement, reposition, resection, supplement and revision

18. Coding Procedures in ICD-10-PCS for Chapter 12 Commonly performed operations on skin and subcutaneous tissue include Excision of skin and subcutaneous lesions Skin grafting Insertion of infusion pumps Insertion of totally implantable vascular access devices

19. Coding Procedures in ICD-10-PCS for Chapter 12 Debridement is the removal of foreign material and contaminated or devitalized tissue from, or adjacent to, a traumatic or infected lesion until the surrounding healthy tissue is exposed There is no root operation of “debridement” in ICD-10-PCS The use of the procedure title of excisional debridement in the Index sends the coder to the root operation of excision Nonexcisional debridement in the Index sends the coder to the root operation of extraction The body parts may be skin or subcutaneous tissue and fascia

20. Exercises Practice coding the conditions included in Chapter 12 of ICD-10-CM for diseases of the skin and subcutaneous tissue as well as the procedures used to treat these conditions by completing the review exercises for Chapter 15.