Pediatric Coding Alert

Look for these synonyms to aid in coding success.

Skin conditions make up more than 12 million annual office visits in children and adolescents, according to the American Family Physician (www.aafp.org/afp/2015/0801/p211.html). Many of these conditions have confusing etiologies, similar-sounding synonyms, and their own coding challenges.

Here are some guidelines to help you precisely code these common pediatric skin conditions.

Know Your Way Around the L70 Codes

Acne comes in a few different forms but is relatively straightforward to code. However, while you probably know that you can find the acne codes in the L70 (Acne) section of your ICD-10, you may not know the specific conditions each one of them documents. You can probably rule out two of them — L70.1 (Acne conglobata) and L70.2 (Acne varioliformis) — immediately as they are extremely rare forms of the condition. Instead, you’ll want to focus your attention on the following:

• L70.0 — Acne vulgaris
• L70.3 — Acne tropica
• L70.4 — Infantile acne
• L70.5 — Acné excoriée (also known as Acné excoriée des jeunes filles and Picker’s acne)
• L70.8 — Other acne
• L70.9 — Acne, unspecified.

Chances are your provider will document the most common of all acne conditions, L70.0, “which is a common skin condition seen most often in teens and young adults that occurs when hair follicles become clogged with oil and dead skin cells,” according to Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/ credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California.

But providers could also document “L70.3, which is a severe type of acne characterized by large painful cysts and nodules that lead to the formation of rounded abscesses and scarring that is inflamed when the weather is hot and humid; or L70.5, which is a type of acne caused by a mental condition characterized by an intense, uncontrollable urge to squeeze and pick at every pimple on the skin to try and make the skin ‘perfect,’” Johnson notes.

Coding caution: While acne and rosacea may appear visually similar, they are different conditions that have separate, distinct diagnoses. However, your provider may refer to one condition as acne rosacea, which is not acne but a form of rosacea that is now more commonly known as papulopustular rosacea. Fortunately, you can easily code this, as the ICD-10 index directs you to use L71.9 (Rosacea, unspecified) for the condition.

Similarly, a condition called perioral dermatitis presents as pimple-looking bumps around a toddler’s mouth. This is also clinically a type of rosacea, coded as L71.0 (Perioral dermatitis).

Clear Up Dermatitis Definition Confusion

Most dermatitis codes fall between L20 (Atopic dermatitis) and L30 (Other and unspecified dermatitis). Confusion arises when you examine the L25.- (Unspecified contact dermatitis) codes more closely. Here, the “unspecified” aspect of these codes does not mean the cause of the dermatitis is unknown.

Rather, it refers to the nature of the contact dermatitis rather than its cause. In fact, the code group contains a number of causal codes that are similar to the allergic- and irritant-contact dermatitis codes, including codes for dermatitis caused by cosmetics (L25.0), drugs in contact with skin (L25.1), dyes (L25.2), and chemical products like cement and insecticides (L25.3).

To add to the confusion, L25.5 (Unspecified contact dermatitis due to plants, except food) does not include nettle rash, which has its own code: L50.9 (Urticaria, unspecified). Fortunately, there is an Excludes1 note that accompanies L25.5 reminding you of the fact.

Synonyms can be helpful keys for coders: Dermatitis codes lurk other places as well, not just between L20 and L30 categories. This is a really confusing aspect of dermatitis coding. There are a variety of conditions that either include dermatitis in their names or have dermatitis as a synonym. “This is where knowing the Includes and Excludes notes is especially useful,” says Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions in Holcombe, Wisconsin. Here is a partial list of some of them for quick reference:

• Juvenile dermatitis herpetiformis is a synonym for chronic bullous disease of childhood (CBDC) and is coded to L12.2.
• Purulent dermatitis, septic dermatitis, and suppurative dermatitis are all synonyms for pyoderma and are coded to L08.0.
• Dry skin dermatitis is a synonym for xerosis cutis and is coded to L85.3.

Coding alert: Some pediatricians may use the term atopic dermatitis as a synonym for eczema. For this reason, atopic dermatitis is probably the most difficult of all skin conditions to code. Normally, you’ll choose a code from L20.- (Atopic dermatitis) such as L20.83 (Infantile (acute) (chronic) eczema). However, there is a clinical difference between atopic dermatitis and eczema. Atopic dermatitis is a type of eczema, but eczema refers to a chronic skin inflammation. You will have to verify with your pediatrician whether a code from L30.- (Other and unspecified dermatitis) is more appropriate.

Confidently Code Other Similar Skin Conditions

There are a few other pediatric skin conditions that present with similar symptoms but have their own codes.

Impetigo: You’ll find the impetigo codes in the L01.- (Impetigo) group. The documentation will likely mention a rash that takes the form of blisters, usually on the extremities or face. The blisters eventually burst and become infected, usually creating pus that hardens to form a yellow crust. Most impetigo is of the nonbullous, or crusted, type, coded to L01.01 (Non-bullous impetigo)

Molluscum contagiosum: Like impetigo, this rash takes the form of tiny, pearlescent skin-colored blisters that appear in small groups around the body. To code this condition, simply use B08.1 (Molluscum contagiosum).

Erythema infectiosum: Code assignment for this diagnosis is simple, and you will only need to use B08.3 (Erythema infectiosum [fifth disease]). The documentation will likely include a rash associated with this infection that looks like the child’s face has been slapped. The rash usually follows a few days after the child develops a general malaise and a low-grade fever.