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3 MIN READ.

Getting Specific: ICD-10 for Dermatology

By: Nathan Brown | February 19th, 2015

Blog Feature


derm_stockThe United States is currently the only developed country in the world that is still using the outdated ICD-9-CM Volume III for diagnosis codes, electronic health records, and insurance claims. However, this is soon to change.  As of October 1st 2015, the official final deadline for ICD-10 implementation, insurance companies will no longer be accepting ICD-9 for diagnosis or procedure codes.  This means that all healthcare professionals must begin learning ICD-10-CM and ICD-10-PCS codes now, especially as they apply to medical specialties.

In this three-part series, we will be examining ten of the most commonly used ICD-9-CM codes for each of three distinct specialties—Dermatology, Ophthalmology, and Plastic Surgery—and comparing them to their respective ICD-10-CM counterparts.

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By doing so, we will see how the high specificity level of ICD-10-CM makes it far superior to ICD-9-CM (which is loaded with obsolete, outdated terminology as well as outmoded and ambiguous codes, not to mention inadequate data that fails to accommodate for a multitude of medical discoveries and advances that have occurred in recent decades).

ICD-10-CM Codes in Dermatology

In this first installment, we will be looking at ten of the more commonly used Dermatology specific codes in the soon-to-be phased out ICD-9-CM system.  We will then look at how these codes can be translated into the new, more specific ICD-10-CM coding language.

Let’s begin with something fairly simple: Psoriasis.

In ICD-9-CM, psoriasis would fall under 696.1 (696 being the general category for Psoriasis, and .1 to denote that it, more or less, does not fall into any of the other available specifying codes).  In ICD-10-CM, Psoriasis would be coded in the following manner:

Primary category: L (0-99, for diseases of the skin and subcutaneous tissue)

2-digit category: 40 (Psoriasis)

So the primary code would be L40, which is then further specified (according to factors such as etiology, anatomic site, and other vital details) to create a final diagnosis code from the following possibilities:

L40.0: Psoriasis vulgaris

L40.1: Generalized pustular psoriasis

L40.2: Acrodermatitis continua

L40.3: Pustulosis palmaris er plantaris

L40.4: Guttate psoriasis

L40.5: Psoriasis, other

L40.50: Arthropathic psoriasis, unspecified

L40.51: Distal interphalangeal psoriatic arthropathy

L40.52: Psoriatic arthritis mutilans

L40.53: Psoriatic spondylitis

L40.54: Psoriatic juvenile arthropathy

L40.59: Other psoriatic arthropathy

L40.8: Other psoriasis

L40.9: Psoriasis, unspecified

Let’s try another: Atopic dermatitis and related conditions, other

This incredibly vague diagnosis is coded in ICD-9-CM as 691.8, which more or less just tells someone that the diagnosis is some form of dermatitis that isn’t “diaper or napkin rash.”  In the ICD-10-CM language, however, there are a number of far more specific coding options.

Primary category: L (0-99, disease of the skin and subcutaneous tissue)

2-digit category: 20 (atopic dermatitis)

So the primary code would be L20, and must now be specified (according to etiology, anatomic site, and other vital details) to create a final diagnosis code from the following possibilities:

L20.0: Besnier's prurigo

L20.8: Other atopic dermatitis

L20.81: Atopic neurodermatitis

L20.82: Flexural eczema

L20.83: Infantile (acute) (chronic) eczema

L20.84: Intrinsic (allergic) eczema

L20.89: Other atopic dermatitis

L20.9: Atopic dermatitis, unspecified

Let’s look at one that’s a little more complex: Contact dermatitis and other eczema due to unspecified cause

This is coded in ICD-9-CM as 692.9, which (inadequately) covers dozens of conditions, from various forms of dermatitis and eczema to beard warts and platinosis.  In ICD-10-CM, however, this umbrella category instead branches out into a number of specific coding options.

Primary category: L (0-99, disease of the skin and subcutaneous tissue)

2-digit category: 23 (allergic contact dermatitis); 24 (irritant contact dermatitis); 25 (unspecified contact dermatitis); or 30 (other and unspecified dermatitis)

In this case, there are several possible primary codes to choose from—L23, L24, L25, or L30.  The specific, final diagnosis code, based on the symptoms and situation, could be any of the following possibilities:

L23.9: Allergic dermatitis

L24.9: Irritant contact dermatitis, unspecified

L25.9: Unspecified contact dermatitis, unspecified cause

L30.0: Nummular dermatitis

L30.2: Cutaneous autosensitization

L30.8: Dermatitis, other specified

L30.9: Dermatitis, unspecified

Our fourth example will move us into a different primary category: Congenital anomaly of the skin, other specified

This is coded in ICD-9-CM as 757.39, identifying it only as a “congenital anomaly of the integument” (757) and “other anomaly of the skin” (.39), which (one must admit) does not explain very much.  In ICD-10-CM, on the other hand, you have far more useful coding possibilities at your disposal.

Primary category: Q (80-89, other congenital malformations)

2-digit category: 81 (epidermolysis bullosa) or 82 (other congenital malformations of the skin)

In this case, there are two possible primary codes—Q81 or Q82.  The specific, final diagnosis code, based on the symptoms and situation, could be any of the following possibilities:

Q81.0: Epidermolysis bullosa simplex

Q81.1: Epidermolysis bullosa letalis

Q81.2: Epidermolysis bullosa dystrophica

Q81.8: Other epidermolysis bullosa

Q81.9: Epidermolysis bullosa, unspecified

Q82.8: Other specified congenital malformations of skin

Q82.9: Congenital malformation of skin, unspecified

Just to make sure you’ve got the idea, we’ll do one more step-by-step example: Benign neoplasm of skin site, unspecified.

This is coded in ICD-9-CM as 216.9.  Let’s see how it would be coded with ICD-10-CM.

Primary category: D (10-36, benign neoplasms, except benign neuroendocrine tumors)

2-digit category: 22 (melanocytic nevi) or 23 (other benign neoplasms of the skin)

In this case, there are two possible primary codes—D22 or D23.  The specific, final diagnosis code, based on the symptoms and situation, could be either of the following possibilities:

D22.9: Melanocytic nevi, unspecified

D23.9: Other benign neoplasm of the skin

You should now have a better understanding of how ICD-10-CM coding works, at least in general.  Therefore, the last five examples have been simplified a bit.  However, they still offer useful reference points for some of the more common ICD-9/10-CM codes that will be used in the Dermatology specialty.

ICD-9-CM Code 216.2—Benign neoplasm of ear and external auditory canal

ICD-10-CM Possibilities:

D22.2: Melanocytic nevi of ear and external auricular canal

D22.20: Melanocytic nevi of unspecified ear and external auricular canal

D22.21: Melanocytic nevi of right ear and external auricular canal

D22.22: Melanocytic nevi of left ear and external auricular canal

D23.2: Other benign neoplasm of skin of ear and external auricular canal

D23.20: Other benign neoplasm of skin of unspecified ear and external auricular canal

D23.21: Other benign neoplasm of skin of right ear and external auricular canal

D23.22: Other benign neoplasm of skin of left ear and external auricular canal

ICD-9-CM Code 701.0—Circumscribed scleroderma

ICD-10-CM Possibilities:

L90.0: Lichen sclerosus et atrophicus

L94.0: Localized scleroderma (morphea)

L94.1: Linear scleroderma

L94.3: Sclerodactyly

ICD-9-CM Code 706.1—Acne, other

ICD-10-CM Possibilities:

L70.0: Acne vulgaris

L70.1: Acne conglobata

L70.3: Acne tropica

L70.4: Infantile acne

L70.5: Acne excoriee des jeunes filles

L70.8: Acne, other

L70.9: Acne, unspecified

L73.0: Acne keloid

ICD-9-CM Code 706.2—Sebaceous cyst

ICD-10-CM Possibilities:

L72.0: Epidermal cyst

L72.2: Steatocystoma multiplex

L72.3: Sebaceous cyst

L72.8: Follicular cysts of the skin and subcutaneous tissue, other

L72.9: Follicular cysts of the skin and subcutaneous tissue, unspecified

ICD-9-CM Code 709.3—Degenerative skin disorders

ICD-10-CM Possibilities:

L92.1: Necrobiosis lipoidica, not elsewhere classified

L94.2: Calcinosis cutis

L98.8: Specified disorder of the skin and subcutaneous tissue, other

Hopefully, this provides those of you in the Dermatology specialty with a firm starting point for understanding the transition from ICD-9-CM to ICD-10-CM.  For those of you in specialties other than Dermatology, such as Ophthalmology and Plastic Surgery, please don’t worry.  We will be getting to you soon, in the next two installments of this blog series. In Part 2, we will take a look at ten of the most commonly used ICD-9/10-CM codes for those in the Ophthalmology specialty.

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