Home Health ICD-9/ICD-10 Alert

Question: Could you please clarify which code to use for skin tears? I have been coding them as superficial injuries with a fourth digit of 8 if they are not infected or fourth digit of 9 if infected (for example, skin tear to arm 913.8). A colleague asked when we might use the wound codes (800 series), which are better payers. I believe it would depend upon the depth of the tear.

California Subscriber

Answer: Before coding a skin tear you should be aware that Medicare considers skin tears to require only simple wound care, so there is no coverage for care of the skin.

Skin tears are superficial injuries, otherwise known as partial thickness wounds and are categorized as to severity. Code for superficial injuries with the 910-919 codes, which include abrasions, friction burns, blisters, splinters and nonvenomous insect bites. Skin tears are common in the elderly.

Most skin tears are caused by some kind of trauma, such as bumping into a wheelchair. So you might be tempted to code for them as trauma wounds for 21 points if they are sequenced as primary. However, in most cases, coding a skin tear as a trauma wound would be considered upcoding.

Good news: Medicare does allow you to code a superficial injury as a trauma wound in the case of a complicated skin tear that requires more than routine wound care to heal. For example, say the patient bumped into his wheelchair and has a Category III skin tear using the Payne-Martin Classification system to classify skin tears. The wound is not healing due to the underlying disease of atherosclerosis. This wound can rightfully be coded as a trauma wound.

Your documentation should include a description of the wound, including drainage, odor, size, and appearance of the surrounding skin, plus the care that must be provided for healing.

Try this: Pictures paint a thousand words, so consider taking pictures of the wound to show its complexity. If infection is present, code the trauma wound as complicated, and add the code for the organism, if known.

Helpful: The Payne-Martin Classification system includes the following categories for classifying skin tears:

• Category I -- a skin tear without tissue loss

• Category II -- a skin tear with partial tissue loss

• Category III -- a skin tear with complete tissue loss, where the epidermal flap is absent.

Category III skin tears are the most likely candidates for "upgrading" to trauma wound code status. Category I and II skin tears can be treated by approximating the skin flap and applying a moist, non-adherent dressing.

Tip: Draw an arrow on the dressing to indicate the direction of the skin tear to minimize any further skin injury during dressing removal.

Unless otherwise indicated, reader questions were answered by Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, TX.