ED Coding and Reimbursement Alert

Question: A patient recently reported to the ED with a rash on his chest and abdominal area. After a level-three service the nonphysician practitioner (NPP) decided that the rash was from an "allergic reaction, cause unknown." Notes indicate that the NPP sent the patient to a dermatologist for further treatment. How should I choose a diagnosis code for this patient?

Answer: There are several possibilities for coding the unknown skin rash. More information from the NPP will help to identify the ICD-9 code to append to 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity...).

When deciding the most appropriate code, consider these options:

You may consider selections from category 692.x (Contact dermatitis and other eczema). This category includes "Dermatitis: Not Otherwise Specified (NOS), contact, occupational, venenata"; and "Eczema (acute or chronic): NOS, allergic, erythematous, occupational." You must also use a fourth or fifth digit with this category, which excludes certain types of dermatitis.