Getting Specific: ICD-10 for Dermatology
By: Nathan Brown | February 19th, 2015
The United States is currently the only developed country in the world that is still using the outdated ICD-9-CM Volume III for diagnosis codes, electronic health records, and insurance claims.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.
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will see how the high specificity level of ICD-10-CM makes it far superior to ICD-9-CM (which is loaded with obsolete, outdated terminology as well as outmoded and ambiguous codes, not to mention inadequate data that fails to accommodate for a multitude of medical discoveries and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
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
L90.0: Lichen sclerosus et atrophicus
L94.0: Localized scleroderma (morphea)
L94.1: Linear scleroderma
ICD-9-CM Code 706.1—Acne, other
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
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
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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