Diseases of the Skin and Subcutaneous Tissue: (ICD-9-CM Chapter 12, Codes 680-709, and ICD-10-CM Chapter 12, Codes L00-L99)



Diseases of the Skin and Subcutaneous Tissue


(ICD-9-CM Chapter 12, Codes 680-709, and ICD-10-CM Chapter 12, Codes L00-L99)



Learning Objectives



1. Apply and assign the correct ICD-9-CM and ICD-10-CM codes in accordance with Official Guidelines for Coding and Reporting


2. Identify major differences between ICD-9-CM and ICD-10-CM related to the skin and subcutaneous tissue


3. Identify pertinent anatomy and physiology of the skin and subcutaneous tissue


4. Identify diseases of the skin and subcutaneous tissue


5. Assign the correct V/Z codes and procedure codes related to the skin and subcutaneous tissue


6. Identify common treatments, medications, laboratory values, and diagnostic tests


7. Explain the importance of documentation in relation to MS-DRGs for reimbursement



Abbreviations/Acronyms











ICD-9-CM Official Guidelines for Coding and Reporting


Please refer to the companion Evolve website for the most current guidelines.




Chapter 12: Diseases Skin and Subcutaneous Tissue (680-709)



a. Pressure ulcer stage codes



1) Pressure ulcer stages


    Two codes are needed to completely describe a pressure ulcer: A code from subcategory 707.0, Pressure ulcer, to identify the site of the pressure ulcer and a code from subcategory 707.2, Pressure ulcer stages.


    The codes in subcategory 707.2, Pressure ulcer stages, are to be used as an additional diagnosis with a code(s) from subcategory 707.0, Pressure ulcer. Codes from 707.2, Pressure ulcer stages, may not be assigned as a principal or first-listed diagnosis. The pressure ulcer stage codes should only be used with pressure ulcers and not with other types of ulcers (e.g., stasis ulcer).


    The ICD-9-CM classifies pressure ulcer stages based on severity, which is designated by stages I-IV and unstageable.



Example


The patient was admitted to the hospital from the nursing home. Upon examination the physician noted a stage II pressure ulcer on the sacrum, 707.03, 707.22 (L89.152).


2) Unstageable pressure ulcers


    Assignment of code 707.25, Pressure ulcer, unstageable, should be based on the clinical documentation. Code 707.25 is used for pressure ulcers whose stage cannot be clinically determined (e.g., the ulcer is covered by eschar or has been treated with a skin or muscle graft) and pressure ulcers that are documented as deep tissue injury but not documented as due to trauma. This code should not be confused with code 707.20, Pressure ulcer, stage unspecified. Code 707.20 should be assigned when there is no documentation regarding the stage of the pressure ulcer.



Example


Patient is in the hospital for pneumonia. It is noted in the physical exam that the patient was recently treated for a pressure ulcer of the heel by skin graft. The graft looks to be progressing as planned, 486, 707.07, 707.25 (J18.9, L89.609).


3) Documented pressure ulcer stage


    Assignment of the pressure ulcer stage code should be guided by clinical documentation of the stage or documentation of the terms found in the index. For clinical terms describing the stage that are not found in the index, the provider should be queried.


4) Bilateral pressure ulcers with same stage


    When a patient has bilateral pressure ulcers (e.g., both buttocks) and both pressure ulcers are documented as being the same stage, only the code for the site and one code for the stage should be reported.


5) Bilateral pressure ulcers with different stages


    When a patient has bilateral pressure ulcers at the same site (e.g., both buttocks) and each pressure ulcer is documented as being at a different stage, assign one code for the site and the appropriate codes for the pressure ulcer stage.


6) Multiple pressure ulcers of different sites and stages


    When a patient has multiple pressure ulcers at different sites (e.g., buttock, heel, shoulder) and each pressure ulcer is documented as being at different stages (e.g., stage 3 and stage 4), assign the appropriate codes for each different site and a code for each different pressure ulcer stage.



Example


Patient has stage IV pressure ulcers on both heels, 707.07, 707.24 (L89.624, L89.614).



Example


Patient has pressure ulcers on both buttocks. The buttock on the right has a stage II ulcer while the left buttock has a stage III ulcer, 707.05, 707.22, 707.23 (L89.323, L89.312).



Example


Patient is transferred from the nursing home with a fever and infected decubitus ulcers. There is an ulcer of the left hip stage III and ulcers of both elbows. The right elbow has a stage I ulcer and the left elbow has a stage II ulcer, 707.04, 707.01, 707.23, 707.21, 707.22 (L89.223, L89.011, L89.022).


7) Patients admitted with pressure ulcers documented as healed


    No code is assigned if the documentation states that the pressure ulcer is completely healed.


8) Patients admitted with pressure ulcers documented as healing


    Pressure ulcers described as healing should be assigned the appropriate pressure ulcer stage code based on the documentation in the medical record. If the documentation does not provide information about the stage of the healing pressure ulcer, assign code 707.20, Pressure ulcer stage, unspecified.


    If the documentation is unclear as to whether the patient has a current (new) pressure ulcer or if the patient is being treated for a healing pressure ulcer, query the provider.



Example


On the discharge summary, the provider documents the following discharge diagnoses: Exacerbation of COPD, hypertension, hyperlipidemia, and a healed sacral decubitus, 491.21, 401.9, 272.4 (J44.1, I10, E78.5).



Example


On the discharge summary, the provider documents the following discharge diagnoses: Exacerbation of COPD, hypertension, hyperlipidemia, and a healing sacral decubitus, 491.21, 401.9, 272.4, 707.03, 707.20 (J44.1, I10, E78.5, L89.159).


9) Patient admitted with pressure ulcer evolving into another stage during the admission


    If a patient is admitted with a pressure ulcer at one stage and it progresses to a higher stage, assign the code for highest stage reported for that site.



Example


Patient is admitted to the hospital from the nursing home for aspiration pneumonia. The admitting provider documents that the patient has a stage II sacral ulcer. At the time of transfer back to the nursing home, the provider documents the ulcer as stage III, 507.0, 707.03, 707.23 (J69.0, L89.153).


Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in Chapter 6.



ICD-10-CM Official Guidelines for Coding and Reporting


Please refer to the companion Evolve website for the most current guidelines.




12. Chapter 12: Diseases of Skin and Subcutaneous Tissue (L00-L99)



a. Pressure ulcer stage codes



1) Pressure ulcer stages


    Codes from category L89, Pressure ulcer, are combination codes that indentify the site of the pressure ulcer as well as the stage of the ulcer.


    The ICD-10-CM classifies pressure ulcer stages based on severity, which is designated by stages 1-4, unspecified stage and unstageable.


    Assign as many codes from category L89 as needed to identify all the pressure ulcers the patient has, if applicable.


2) Unstageable pressure ulcers


    Assignment of the code for unstageable pressure ulcer (L89.– –0) should be based on the clinical documentation. These codes are used for pressure ulcers whose stage cannot be clinically determined (e.g., the ulcer is covered by eschar or has been treated with a skin or muscle graft) and pressure ulcers that are documented as deep tissue injury but not documented as due to trauma. This code should not be confused with the codes for unspecified stage (L89.– –9). When there is no documentation regarding the stage of the pressure ulcer, assign the appropriate code for unspecified stage (L89.– –9).


3) Documented pressure ulcer stage


    Assignment of the pressure ulcer stage code should be guided by clinical documentation of the stage or documentation of the terms found in the Alphabetic Index. For clinical terms describing the stage that are not found in the Alphabetic Index, and there is no documentation of the stage, the provider should be queried.


4) Patients admitted with pressure ulcers documented as healed


    No code is assigned if the documentation states that the pressure ulcer is completely healed.


5) Patients admitted with pressure ulcers documented as healing


    Pressure ulcers described as healing should be assigned the appropriate pressure ulcer stage code based on the documentation in the medical record. If the documentation does not provide information about the stage of the healing pressure ulcer, assign the appropriate code for unspecified stage.


    If the documentation is unclear as to whether the patient has a current (new) pressure ulcer or if the patient is being treated for a healing pressure ulcer, query the provider.


6) Patient admitted with pressure ulcer evolving into another stage during the admission


    If a patient is admitted with a pressure ulcer at one stage and it progresses to a higher stage, assign the code for the highest stage reported for that site.


Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in Chapter 7.





Anatomy and Physiology


The skin and its accessory organs constitute the integumentary system (Figure 18-1), whose functions include protection, temperature regulation, sensory reception, and vitamin D synthesis.


image
Figure 18-1 The skin. A, Three layers of the skin. B, Epidermis.

The skin is composed of three layers: epidermis, dermis, and subcutaneous layers. The outer layer of the skin, or the epidermis, serves as a protective barrier and prevents the entrance of disease-causing organisms. The dermis, or middle layer, is composed of fibrous connective tissues that make it strong and elastic. This middle layer contains blood vessels, nerve fibers, sebaceous glands, and some hair follicles. The subcutaneous layer contains fat, sweat glands, and additional hair follicles.


The integumentary system also has accessory organs; these include hair, glands, and nails. Three types of glands are located in the skin: sweat glands, sebaceous glands, and mammary glands. The sweat glands assist in temperature regulation, and the sebaceous glands secrete an oily substance, sebum, which lubricates the hair and skin.



Disease Conditions


Diseases of the Skin and Subcutaneous Tissue (680-709), Chapter 12 in the ICD-9-CM code book, is divided into the following categories:

















CATEGORY SECTION TITLES
680-686 Infections of Skin and Subcutaneous Tissue
690-698 Other Inflammatory Conditions of Skin and Subcutaneous Tissue
700-709 Other Diseases of Skin and Subcutaneous Tissue

Diseases of the Skin and Subcutaneous Tissue (L00-L99), Chapter 12 in the ICD-10-CM code book, are divided into the following categories:



































CATEGORY SECTION TITLES
L00-L08 Infections of the skin and subcutaneous tissue
L10-L14 Bullous disorders
L20-L30 Dermatitis and eczema
L40-L45 Papulosquamous disorders
L50-L54 Urticaria and erythema
L55-L59 Radiation-related disorders of the skin and subcutaneous tissue
L60-L75 Disorders of skin appendages
L76 Intraoperative and postprocedural complications of skin and subcutaneous tissue
L80-L99 Other disorders of the skin and subcutaneous tissue


Infections of the Skin and Subcutaneous Tissue


Carbuncle and Furuncle


Another name for a furuncle is a boil, and a cluster of boils is known as a carbuncle (Figure 18-2). The organism that is responsible for a boil is Staphylococcus. This organism enters the body through a hair follicle. An additional code is required to identify the organism responsible.


image
Figure 18-2 A, Furuncle. B, Carbuncle.

Related posts:

  1. Diseases of the Digestive System: (ICD-9-CM Chapter 9, Codes 520-579, and ICD-10-CM Chapter 11, Codes K00-K95)
  2. Diseases of the Blood and Blood-Forming Organs: (ICD-9-CM Chapter 4, Codes 280-289, and ICD-10-CM Chapter 3, Codes D50-D89)
  3. Diseases of the Circulatory System: (ICD-9-CM Chapter 7, Codes 390-459, and ICD-10-CM Chapter 9, Codes I00-I99)
  4. Introduction to ICD-10-PCS

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Jun 14, 2017 | Posted by in GENERAL SURGERY | Comments Off on Diseases of the Skin and Subcutaneous Tissue: (ICD-9-CM Chapter 12, Codes 680-709, and ICD-10-CM Chapter 12, Codes L00-L99)

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