ED Coding and Reimbursement Alert

You may have to search other chapters to find the diagnosis code you need for these systems

An increasing number of ED presentations involve diseases of the digestive system. That includes everything from ingestion to elimination, to put it delicately, and involves diseases of oral cavity and salivary glands, diseases of esophagus, stomach and duodenum, diseases of the appendix, hernia, non-infective enteritis and colitis, diseases of the liver, gallbladder, biliary tract and pancreas. Common ED presentations in this family include dental presentations like loss of teeth due to trauma, complete or partial (K08.111 – K08.119 and K08.411 – K08.419), gastro-esophageal reflux (K21.x), Acute appendicitis (K35.x) or a Fecal impaction (K56.41), says Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA Certified ICD-10 Instructor and President, Edelberg Compliance Associates.

Find Your Way Through The Digestive System Diagnosis Maze

Patients with no dental insurance often come to the ED for tooth related concerns. As many as five percent of patients have dental complaints such as, patients presenting with dental caries (K02.9) require identification of the location and type. For example, documentation should address whether cavity is on chewing surface limited to enamel (K02.51); penetrating into dentin (K02.52); or into pulp (K02.53); or coronal, pit and fissure, smooth surface and cavities of root (K02.7) and pain of teeth (K08.8) for a not otherwise specified toothache.

At the other end of the spectrum, diarrhea can be related to a number of conditions, so the coder should carefully review the Alphabetic index before assigning the code. Unspecified diarrhea (R19.7) and functional diarrhea (K59.1) and psychogenic diarrhea (F45.8) are found in additional classifications, says Edelberg.

Ensure You’re In the Right Chapter For Skin-Related Presentations

The majority of skin treatments in the ED involve laceration repairs as the result of traumatic injury that are coded in other ICD-10 chapters. Chapter 12 Diseases of Skin and Subcutaneous Tissue primarily describes diseases of the skin and subcutaneous tissues. It also includes more than just skin conditions as conditions of the nails, sweat glands, hair and hair follicles are referenced here. But several skin related presentations should actually be coded from other ICD-10 Chapters, warns Edelberg.

Be aware that disorders of skin and subcutaneous tissues resulting from otherwise classified diseases must be coded first to the underlying disease. However, skin disorders in diabetes (E08-E13 with .62) are coded elsewhere. Disorders of the skin and subcutaneous tissue that are unspecified in provider documentation are coded L98.9.

Coding tip: You should review the documentation to determine whether the condition is an adverse effect from proper drug administration or whether it is a poisoning due to the incorrect use of the drug. To identify causation, go to codes T36 through T65 which will be used to identify the cause of the adverse effect, Edelberg explains.

Debridement also appears in this chapter and is classified as either excisional or non-excisional. Non excisional includes brushing, irrigating, scrubbing or washing of the wound, Edelberg adds.

Check Out These Case Examples:

Edelberg provides these real world ED presentations that demonstrate that the correct ICD-10 diagnosis may come from a different chapter than the organ system involved.

Scenario 1: A patient falls while camping several days ago with his family and lacerates his right knee. He presents to the emergency department complaining of pain at the site of the laceration and is concerned that it may have some foreign material in the laceration. He also sees some pus and it concerned for infection. The emergency physician cleanses and debrides the wound and starts the patient on antibiotics.

Principle diagnosis:

Laceration with foreign body, right knee, initial encounter S81.021

Additional Diagnosis:

Cellulitis Rt. knee (Rt. lower limb) L03.115

Scenario 2: An elderly female presents to the emergency department with itching and redness to her left eyelid. The emergency physician examines the eyelid and diagnosis contact dermatitis of the left eyelid, prescribes eye drops and discharges the patient home.

Principle diagnosis:
Contact dermatitis of lt. eyelid (unspecified upper/lower) H01.116

Note: This dermatitis is coded from the chapter on Eyes and Adnexa rather than Skin.