Dermatology Coding Alert

Location criteria should improve your accuracy

It's official: Starting Oct. 1, you'll have a new set of specific codes to help you pinpoint decubitus ulcer sites (707.00-707.09) and a new code to describe eczema due to animal dander (692.84).

The Centers for Disease Control and CMS have unveiled their new 2005 ICD-9 codes, and you'll have until Oct. 1 to implement the changes. Because payers do not allow a grace period for the new codes, you should ensure that your superbills are updated by Sept. 30.

The nine new decubitus ulcer codes are an "exciting" addition to ICD-9 because they will allow dermatology practices to better explain the location of the ulcers throughout the body, says Lori Sorenson, CPC, coding specialist at Billing Surgical Clinic in Billings, Mont.

Case example: The patient presents with a painful decubitus ulcer on the upper back that the dermatologist decides to subsequently excise.

Old way: Before the addition of the new codes, you would have reported the diagnosis code 707.0 (Decubitus ulcer), Sorenson says.

New way: But now, referring to the case example above, you should report one of the new 707-series codes to specify the location of the ulcer the dermatologist excised, Sorenson says:

707.00 -- Decubitus ulcer, unspecified site;
707.01 -- Decubitus ulcer, elbow;
707.02 -- Decubitus ulcer, upper back;
707.03 -- Decubitus ulcer, lower back;
707.04 -- Decubitus ulcer, hip;
707.05 -- Decubitus ulcer, buttock;
707.06 -- Decubitus ulcer, ankle;
707.07 -- Decubitus ulcer, heel; and
707.09 -- Decubitus ulcer, other site.

Remember: It is always important to code to the highest level, says Karin Schuman, CPC, coding compliance manager for Healthlink Minnesota in Minneapolis.

With the addition of these codes and the new level of specificity they bring, Schuman says, your diagnosis coding should increase your diagnosis-related group level, which in turn improves your reimbursement.

(See "4 Questions Guide Your Ulcer Reporting" for helpful hints when reporting ulcers.)

One more thing: The new ICD-9 codes for fall 2004 also include a new code for dermatitis and eczema caused by animal dander when animal (cat, dog, etc.) hair and dander causes dermatitis or eczema. You can report ICD-9 code 692.84 (Contact dermatitis and other eczema due to animal [cat] [dog] dander) beginning Oct. 1.

The addition of this code to ICD-9 allows for greater specificity as to the cause of the dermatitis, says Roger Hettinger, CPC, CMC, CCS-P, coding specialist at Sioux Valley Clinic in Sioux Falls, S.D.

Old way: Prior to the 2004 changes, no code existed specifically for dermatitis or eczema due to animal hair and dander, so you would report code 692.x (Contact dermatitis and other eczema) if the patient appeared with dermatitis symptoms due to an animal, Hettinger says. The new code should bring you more accurate reporting for contact dermatitis and allow you to bill the most appropriate code when animals are the cause of your patients'itching and scratching.

Case example: Apatient comes to your dermatology office for a routine skin check. The dermatologist examines the patient to check for any abnormalities throughout the patient's body (99212, Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history, a problem-focused exam, and straightforward medical decision-making).

During the examination, the doctor finds that the patient has a small patch of eczema on her hand. The patient tells the doctor that the patch of skin developed the day after the patient got a new cat. The dermatologist debrided the area (11000, Debridement of extensive eczematous or infected skin; up to 10% of body surface) and prescribed a topical ointment to treat the eczema.

New way: In this scenario, you should now also report 692.84, in addition to 99212 and 11000, coding experts say.

To review a full listing of the new ICD-9 codes, visit the CMS Web site at http://www.cms.hhs.gov/medlearn/icd9code.asp#coding.