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The Final Countdown: ICD-10 for Dermatology

By: Nathan Brown | September 18th, 2015

The Final Countdown: ICD-10 for Dermatology Blog Feature

Well, folks… here we are.

After years and years of political bickering, last minute delays, and long postponements, the final deadline for ICD-10 implementation in the United States is now less than two short weeks away.  There were lot of people who still thought it wouldn’t happen in 2015, and if some had their way it would still not be happeningfashion-wristwatch-time-watch.  However, unless some kind of unexpected zero hour delay occurs between now and the October 1 deadline, ICD-10 is coming to a Dermatology practice near you (in fact, it’s coming to your Dermatology practice).

It’s the Final Countdown, people! 

Somebody cue me up a 1980s-style “get ready” montage!

Short on time? Click here to discover how a Coding Assistance Solution can  simplify your practice's transition from ICD-9 codes to ICD-10.

On this blog, we’ve done our best over the last nine months or so to give our readers as many resources as possible to get prepared for the switch to ICD-10 in advance.  In fact, back in February I provided our readers with a three-part blog series that provided a detailed look at how some of the more commonly used ICD-9 codes in Dermatology, Ophthalmology, and Plastic Surgery would translate over to ICD-10.  For those who might be in need of a little extra help in making the ICD-10 transition, I also wrote a blog post in March about the benefits of having Nextech’s intuitive ICD-10 solution—NexCode.

Seeing as how we are so close to the transition, I figured it might be a good idea to give readers one last refresher lesson.  Therefore, in this three-part series, we will take a look at five more commonly used ICD-9-CM codes for each of three distinct specialties—Plastic Surgery, Dermatology, and Ophthalmology—and compare them to their respective ICD-10-CM counterparts.

ICD-10-CM Codes in Dermatology

In Part 1, we discussed common ICD-9 and ICD-10 codes specific to Plastic Surgery.  In this second part of the series, we will be discussing five fairly common codes specific to Dermatology (followed by Ophthalmology in Part 3) in the soon-to-be phased out ICD-9-CM system.  Then we will look at how these codes should be translated into the more specific ICD-10-CM coding language.

Let’s start with something fairly simple—rosacea

In ICD-9-CM, this would fall under 695.3 (695 being the general category for “erythematous conditions,” and .3 to denote “rosacea”).  In ICD-10-CM, however, your coding will need to be specific to symptoms (if applicable) and would be coded in the following manner:

Primary category: L (60-75, for disorders of skin appendages)

2-digit category: 71 (rosacea)

This means the primary code for this in ICD-10-CM would be L71, which must now be further specified according to the related symptom/condition to create a final diagnosis code from the following potential options:

L71.0: Perioral dermatitis

L71.1: Rhinophyma

L71.8: Other rosacea

L71.1: Rosacea, unspecified

Let’s try another one—acute lymphadenitis

In ICD-9-CM, this would fall under 683(683 being the umbrella category for “acute lymphadenitis”).  This is a fairly umbrella-matured code, since it lacks further specification as to location.  However, in ICD-10-CM, acute lymphadenitis would be coded in the following manner:

RELATED: The Final Countdown: ICD-10 for Plastic Surgery

Primary category: L (00-08, for infections of the skin and subcutaneous tissue)

2-digit category: 04 (acute lymphadenitis)

This means the primary code for this in ICD-10-CM would be L04, which must now be further specified according to location in order to create a final diagnosis code:

L04.0: Acute lymphadenitis of face, head and neck

L04.1: Acute lymphadenitis of trunk

L04.2: Acute lymphadenitis of upper limb

L04.3: Acute lymphadenitis of lower limb

L04.8: Acute lymphadenitis of other sites

L04.9: Acute lymphadenitis, unspecified

Keep in mind that L04.9 may not be considered an acceptable billable code in some circumstances.  Remember that, when it comes to ICD-10-CM, it’s always best to use a code that is as specific as possible in order to avoid billing/claim rejections.

For our third example, let’s look at something a bit more complex—acneiform drug eruption

In ICD-9-CM, this would fall under 692.3 (692 being the general category for “contact dermatitis and other eczema,” and .3 to denote “contact dermatitis and other eczema due to drugs and medicines in contact with skin”).  The problem here is that this code encompasses a myriad of possible diseases, causes, and symptoms.  In ICD-10-CM, acneiform drug eruption would be coded as follows:

Primary category: L (20-30, for dermatitis and eczema)

2-digit category: 25 (unspecified contact dermatitis)

This means the primary code for this in ICD-10-CM would be L25, which must now be further specified according to cause:

L25.0: Unspecified contact dermatitis due to cosmetics

L25.1: Unspecified contact dermatitis due to drugs in contact with skin

L25.2: Unspecified contact dermatitis due to dyes

L25.3: Unspecified contact dermatitis due to other chemical products

L25.4: Unspecified contact dermatitis due to food in contact with skin

L25.5: Unspecified contact dermatitis due to plants, except food

L25.8: Unspecified contact dermatitis due to other agents

L25.9: Unspecified contact dermatitis, unspecified cause

Keep in mind that L25.9 may not be considered an acceptable billable code in some circumstances.  As already mentioned, it’s always best to use a code that is as specific as possible in order to avoid billing/claim rejections when using ICD-10-CM.

Let’s move on to our fourth example—dermatophytosis, corporis

In ICD-9-CM, this would fall under 110.5 (110 being the category for “dermatophytosis,” and .5 to denote “dermatophytosis of the body”).  Unfortunately, this does not say much when it comes to specific type, and could even include herpes (without specifically stating that it is present). In ICD-10-CM, dermatophytosis would be coded in the following manner:

Primary category: B (35-49, for mycoses)

2-digit category: 35 (dermatophytosis)

This means the primary code for this in ICD-10-CM would be B35, which must now be further specified by choosing from the following options:

B35.0: Tinea barbae and tinea capitis

B35.1: Tinea unguim

B35.2: Tinea manuum

B35.3: Tinea pedis

B35.4: Tinea corporis

B35.5: Tinea imbricata

B35.6: Tinea cruris

B35.8: Other dermatophytosis

B35.9: Dermatophytosis, unspecified

Keep in mind that B35.9 may not be considered an acceptable billable code in some circumstances.  Once again, it’s always best to use whichever code is most specific to the patient’s situation in order to avoid billing/claim rejections when using ICD-10-CM.

Now for our fifth and final step-by-step example—strawberry/cherry angioma (hemangioma)

In ICD-9-CM, this would fall under 228.01 (228 being the general category for “hemangioma and lymphangioma, any site,” and .01 to denote “hemangioma of the skin and subcutaneous tissue”).  This is an extremely vague code, since it does not specify type or location.  In ICD-10-CM, strawberry angioma would be coded in the following manner:

RELATED: Delays in ICD-10 code processing for Medicaid programs in four states

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

2-digit category: 18 (hemangioma and lymphangioma, any site)

This means the primary code for this in ICD-10-CM would be D18, which must now be further specified according to type (dermatochalasis) and location to create a diagnosis code:

D18.0: hemangioma

However, the above code does not specify a location, and therefore it is not yet a billable code.  In order to create a billable code, it must be further specified from the following potential options based on location:

D18.00: hemangioma, unspecified site

D18.01: hemangioma of skin and subcutaneous tissue

D18.02: hemangioma of intracranial structures

D18.03: hemangioma of intra-abdominal structures

D18.09: hemangioma of other sites

In this case, both D18.00 and D18.09 may not be considered acceptable billable codes in some circumstances.  I can’t emphasize this enough—always use whichever code is most specific to the patient’s situation in order to avoid billing/claim rejections when using ICD-10-CM.

I hope this article has been helpful for those of you in the Dermatology specialty, giving you a bit more insight into the fast approaching final transition from ICD-9 to ICD-10.  For those of you in Ophthalmology, we will be getting to you in Part 3 of this blog series.

ICD-10 is upon us, ladies and gentlemen… it’s time to get serious.

Thanks for reading!