# Need help with ICD-10 CODING AK'S



## hmheldt (Sep 17, 2015)

With regards to coding patients with AK's which requires the "initial, subsequent, sequela" as 7th digit. Is the coding based on AK's in general or per lesion? For example, if we see a pt with AK's on the right cheek and destroy them, then they return in a month with additional AK's but on the left cheek. Is this an initial encounter for the AK's on the left cheek or a subsequent encounter for the treatment for AK's? 

What if AK's appear again on one of the treated cheeks but it isn't clear if it's the destroyed ones reappearing or new ones? 

Can anyone help with this??


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## mitchellde (Sep 17, 2015)

hmheldt said:


> With regards to coding patients with AK's which requires the "initial, subsequent, sequela" as 7th digit. Is the coding based on AK's in general or per lesion? For example, if we see a pt with AK's on the right cheek and destroy them, then they return in a month with additional AK's but on the left cheek. Is this an initial encounter for the AK's on the left cheek or a subsequent encounter for the treatment for AK's?
> 
> What if AK's appear again on one of the treated cheeks but it isn't clear if it's the destroyed ones reappearing or new ones?
> 
> Can anyone help with this??



The code for actinic keratosis does not require the 7th characters A,D,or S.  To add them will make the code invalid.  Where are you seeing that this is a required character for this code?


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## hmheldt (Sep 18, 2015)

*AK coding question*

When coding AKs in I-10 you need 2 codes. The 2nd code (exposure to sunlight for example) requires 7 digits.


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## yolandasimmons (Oct 12, 2015)

*AK's Second Code*

When coding the second code for AK's using the X32 codes, would the 7th digit A,D,or S pertain to the visits or the initial, subsequent or late affect diagnosis?


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## mitchellde (Oct 12, 2015)

The A, D, and S assignment applies to the patient encounter for active treatment.  If there is no active treatment for a previously diagnosed AK then it will be a D.


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## AprilSueMadison (Oct 12, 2015)

We are not sending out the X code.  CMS had a release that covered myths and one of them noted that external causes were not required.  If you look at L57.0, it does show to code X32 with it if it is due to sun exposure.  Looking at X32 though has a note to not code with L55-L59.  

While I'm not 100% sure it is the correct path, we are not sending out X32 due to the contradiction and the CMS note.


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## swagg48 (Oct 12, 2015)

Our office took the same approach with code L57.0 and X32 for the same reason; inconsistency. We don't send L57.0 and X32 together.


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## Lisapurple216 (Nov 18, 2015)

We didn't send the L57 and X32 together either but now we are getting denials. Anyone else having a problem with this. Thanks.


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## CatchTheWind (Nov 23, 2015)

We also have not used the X32, and have not gotten denials yet.  What payer did you get a denial from?  Are you sure the reason is the omission of the external cause code?


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## robynreynon (Dec 17, 2015)

We got denials for not using it as well... As far as encounter type, we are most of the time using the A for initial for the fact that the encounter type is on the _exposure to sunlight_ and not on the AK itself. So our reasoning behind this is that they are in active treatment for the sunlight exposure, regardless of if it is a new AK lesion.. We haven't gotten any denials yet for that, and as I'm sure you know, it is a very common coding scenario in derm. It's all just kind of learn as you go at this point with ICD-10.


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