41 terms

ICD 10 Diseases of the Skin chapter 12 ( Chapter 22-Chisen)

Chapter 22 -Chisen
Infections of skin/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, L60-75
Intraoperative and postprocedural complications of skin and subcutaneous tissue
Other disorders of the skin and subcutaneous tissue
Congenital conditions of skin, hair, and nails are classified in categories
Dermatitis and eczema are used synonymously and interchangeably in
Types of dermatitis:
Allergic contact
Irritant contact
Category L23 classifies allergic contact dermatitis due to skin contact with:
Chemical products
Category L24 classifies irritant contact dermatitis due to skin contact with:
Oils and greases
Category L25 classifies contact dermatitis
that is not specified as allergic or irritant contact dermatitis
Category L27 is for dermatitis due to substances taken internally.
When coding dermatitis caused by medicines, first determine whether the condition is an adverse effect due to the proper administration of a drug, or a poisoning due to the incorrect use of the drug.
A code from categories T36-T65
should be assigned to indicate the way in which the poisoning or adverse effect occurred (accidental, intentional self-harm) and the type of drug involved.
Sequencing will depend on the circumstances.
If dermatitis is a poisoning (due to incorrect use of the drug
Assign the category T36-T65 code first.
T36.0x1A + L27.0, Initial encounter for dermatitis due to accidental ingestion of mother's penicillin tablets
If dermatitis is an adverse effect due to proper administration of a drug
Assign category T36-T65 as an additional code.
L27.0 + T36.0x5A, Initial encounter for dermatitis due to penicillin tablets taken as prescribed
Palmar plantar erthrodysesthesia (PPE) is an example of a specific dermatitis that occurs as an adverse reaction to antineoplastic or biologic drugs used for cancer treatment.
Small amounts of chemotherapy can leak from the capillaries, damaging tissue in the palms of the hands and soles of the feet.
Assign code L27.1, followed by T45.1x5A, for PPE due to antineoplastic antibiotics
A skin disorder resulting in symmetrical, red, raised skin areas all over the body. The patches often resemble targets with their dark circles and purple-gray center.
May occur in response to medications, infections, or illness and could cause severe systemic systems.
Exact cause is unknown.
Erythema Multiforme—Category L51
Patients with erythema multiforme may also suffer from other associated manifestations that should be coded separately, such as:
Corneal ulcer—H16.0-
Ulcers of the Skin
Most chronic ulcers of the skin are classified in categories L89, Pressure ulcer, and L97, Nonpressure chronic ulcer of lower limb, NEC.
Assign code I96
first if gangrene is present with ulceration
The L97 code
may be principal or first-listed if no underlying condition is documented as the cause of the ulcer.
Pressure Ulcer—Category L89
Pressure ulcers, are combination codes that identify the site and stage of the ulcer.
Fifth character identifies the specific site:
Pressure ulcer elbow—L89.0-
Pressure ulcer back—L89.1-
Pressure ulcer buttock—L89.3-
Sixth character indicates the severity of the ulcer (unstageable, stage 1, stage 2, stage 3, stage 4, or unspecified stage).
Stasis ulcers are ordinarily due to varicose veins of the lower extremities
category I83.
If the physician documents stasis ulcer, but identifies a cause other than varicose veins, code the condition to I87.2, Venous insufficiency (chronic) (peripheral).
Further research must be done when the title of the code suggested by the Alphabetic Index does not identify the condition correctly.
Although the Index leads to varicose veins, this code should not be assigned if no varicosities are present.
Cellulitis of the skin
Cellulitis is an acute, diffuse infection of skin and soft tissues that commonly results from a break in the skin, such as a puncture wound, laceration, or ulcer.
Cellulitis usually presents as an abrupt onset of redness, swelling, and pain; however, coders should not assume that a reference to redness at the edges of a wound or an ulcer represents cellulitis.
Cellulitis of the Skin: Coding Example
A patient suffered laceration of the right lower leg while on a hiking trip two days ago and comes to the hospital on his return. By the time he is seen, cellulitis is beginning to develop. The wound is cleansed of foreign material, nonexcisional debridement is carried out, and antibiotics are started for the cellulitis.
Principal diagnosis—S81.821A, Laceration with foreign body, right lower leg, initial encounter
Additional diagnosis—L03.115, Cellulitis of right lower limb
Procedure—0HDKXZZ, Extraction of right lower leg skin, external approach
Both cellulitis and lymphangitis are included in category L03; however, separate codes are available
Postoperative Cellulitis
Cellulitis may occur in a postoperative wound or could result from intravenous therapy.
For example: A patient had an appendectomy six days ago and is now readmitted with evidence of staphylococcal cellulitis of the operative wound.
Principal diagnosis—T81.4xxA, Infection following procedure
Additional diagnosis—L03.311, Cellulitis of abdominal wall
Additional diagnosis—B95.8, Staphylococcus
Cellulitis with ulcer
Cellulitis may develop as a complication of chronic skin ulcers.
Cellulitis and chronic skin ulcer require two codes.
Assign code series L89 or L97, or assign subcategory L98.4 plus the code for the cellulitis.
Designation of the principal diagnosis (cellulitis versus ulcer) depends on the circumstances of the admission.
Cellulitis with Ulcer and Gangrene
Cellulitis described as gangrenous is classified to code I96.
If an ulcer or injury is present with gangrene, the gangrene is coded first, followed by a code for the ulcer or injury.
This practice follows the instructional notes in the Tabular List to code first any associated gangrene.
Other Cellulitis
Cellulitis can occur in other areas besides skin.
Assign codes from other chapters as appropriate.
Cellulitis of female external genital organs is categorized as an inflammatory condition and is assigned code N76.4.
Pelvic cellulitis in women is classified as an inflammatory condition (code N73).
Pelvic cellulitis following abortion, delivery, or molar or ectopic pregnancy, is classified to chapter 15 of ICD-10-CM.
For males, pelvic cellulitis is assigned to K65.0, Generalized (acute) peritonitis.
Excisional debridement
Surgical removal or cutting away of tissue, necrosis, or slough.
Classified to root operation "excision."
May be performed by a physician and/or other health care provider.
Excisional debridement involves an excisional as opposed to a mechanical (brushing, scrubbing, or washing) debridement.
Uses a scalpel to remove devitalized tissue.
Documentation of excisional debridement should be specific regarding the type of debridement.
Query the physician if the documentation is not clear.
Nonexcisional debridement
Nonexcisional debridement involves the nonoperative brushing, irrigating, scrubbing, or washing of devitalized tissue, necrosis, slough, or foreign material.
Classified to root operation "extraction" (the "pulling or stripping out or off all or a portion of a body part by use of force") except when performed by irrigating the tissue, which is coded to "irrigation" in the Administration Section of ICD-10-PCS.
Performed by a physician or other health care personnel.
Nonexcisional debridement
Versajet is an example of nonexcisional debridement.
Consists of an ultra high-pressure generator with a console and disposable attachments.
A natural vacuum created by the jet stream removes tissue fragments.
Specialized features allow physicians to debride traumatic wounds, chronic wounds, or other soft tissue lesions and to aspirate and remove contaminants or other debris.
Another example of nonexcisional debridement is ultrasonic debridement.
Other debridement
When coding excisional debridement of areas other than skin, code to the root operation "excision" of the specific body part.
When coding multiple-layer debridements of the same site, assign a code only for the deepest layer of debridement.
Example: Open excision and debridement of coccyx wound, including the bone, is coded 0QBS0ZZ, Excision of coccyx, open approach.
Debridement carried out in conjunction with another procedure is often included in the code for the procedure, but not always.
Dermal regenerative graft
is used to replace skin layers to treat severe burns.
"Replacement" ("putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part") is the root operation for this new technology.
The approach is "external."
The sixth character identifies the use of:
Synthetic substitutes - J
Autologous tissue substitutes - 7
Nonautologous tissue substitutes - K
Dermal regenerative graft
Synthetic skin substitutes include the following biologic skin replacement systems:
Artificial skin NOS
Creation of "neodermis"
Decellularized allodermis
Integumentary matrix implants
Prosthetic implant of dermal layer of skin
Regenerate dermal layer of skin
Failure and Rejection of Dermal Regenerative Grafts
Assign code T85.693-, Other mechanical complication of artificial skin graft and decellularized allodermis, for failure or rejection of dermal regenerate grafts.
Assign codes T86.820, Skin graft (allograft) rejection, and T86.821, Skin graft (allograft) (autograft) failure, for complications of other skin graft.