Pediatric Coding Alert

And don’t forget to take note of these 2 great expert tips.

Of all the different skin conditions that affect pediatric patients, dermatitis presents a real challenge for coders. The condition has confusing etiologies, many similar-sounding synonyms, and even some counterintuitive code choices.

To help you code the condition to the greatest specificity possible, here are three things you should remember, along with a couple of great coding tips from two experts.

1. Remember the Difference Between Allergic- and Irritant- Contact Dermatitis

Medically, the two conditions are very different. Irritant-contact dermatitis is usually localized to the area affected by the contact, while allergic-contact dermatitis affects a much wider area of the patient’s skin.

Fortunately, the two different conditions have two different ICD-10 codes, L23.- (Allergic contact dermatitis) and L24.- (Irritant contact dermatitis). The codes are also further subdivided by the agent causing the reaction. So, if your pediatrician documents that a patient has a skin allergy to rubber, you would document L23.5 for an allergic-contact condition, and L24.5 if that condition was due to irritant contact.

And remember: L23.3 (Allergic contact dermatitis due to drugs in contact with skin) and L24.4 (Irritant contact dermatitis due to drugs in contact with skin) both feature an additional code note that tells you to code for the drug using T36-T50 along with a fifth or sixth character of 5 in the case of adverse effects, if applicable.

2. Remember Many Dermatitis Conditions Have Synonyms

Not only does this create a coding headache, as your pediatrician may use terminology that is different from terminology you may be familiar with, but it might also lead you out of the L20-L30 (Dermatitis and eczema) code block of ICD-10, where most of the dermatitis codes exist.

This is particularly true of eczema, which is subject to plenty of confusion because “the note that accompanies the L20-L30 code block states that ‘In this block the terms dermatitis and eczema are used synonymously and interchangeably,’” says Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions in Holcombe, Wisconsin.

Some pediatricians may use the term atopic dermatitis as a synonym for eczema, but there is a clinical difference between the two conditions. For some pediatric forms of eczema, you would choose a code from L20.- (Atopic dermatitis) such as L20.83 (Infantile (acute) (chronic) eczema), though other forms of eczema are codable to L30.- and other chapters of ICD-10 per the index.

And take note of these peds-specific synonyms: Experienced peds coders know that several common pediatric conditions are often better known by their synonyms and not their clinical or ICD-10 terms. So, cradle cap should actually be coded as L21.0 (Seborrhea capitis), while diaper rash codes to L22 (Diaper dermatitis) and juvenile dermatitis herpetiformis, a blistering skin condition, should be coded as L12.2 (Chronic bullous disease of childhood).

3. Remember Some Dermatitis Codes Are not What They Seem

One subgroup of the dermatitis codes that causes a great deal of coding confusion is L25.- (Unspecified contact dermatitis). That’s because the “unspecified” aspect of these codes does not mean the cause of the dermatitis is unknown, but that the nature of the contact dermatitis is not due to either contact or an allergic reaction. However, like the allergic- and irritant-contact dermatitis codes, the L25.- codes are also divided by cause, including L25.0 (… cosmetics) L25.1 (… drugs in contact with skin), L25.2 (… dyes), and L25.3 (… due to other chemical products).

Another code in the group, L25.5 (Unspecified contact dermatitis due to plants, except food), is also confusing in that it cannot be used for one particularly common form of contact dermatitis — nettle rash. This has its own code, which is also outside of the L20-L30 code block: L50.9 (Urticaria, unspecified). Fortunately, there is an Excludes1 note that accompanies L25.5 to remind you of the fact.

Avoid Confusion With These Pro Coding Tips

“The biggest problem I see is lack of detail from providers to code more specifically anything other than L30.9 [Dermatitis, unspecified] for dermatitis or eczema,” Rasmussen notes. “That’s because providers often only have enough information to document the symptoms of the skin problem, such as rash [R21], hives [L50.9], or skin inflammation [L08.9] rather than providing a more definitive diagnosis,” adds Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P, author of the AMA book, Risk Adjustment Documentation and Coding.

To avoid these problems, here are two more great tips.

Tip 1: “If you’re unsure, look up the terminology on the internet,” Rasmussen suggests. Reputable sources you can use include the Centers for Disease Control and Prevention (CDC) ICD-10 search tool found at icd10cmtool.cdc.gov/?fy=FY2019. “You can also consult the government ICD-10-CM pdf files that are available, because they are easily searched for documented terms to validate diagnoses and codes,” adds Bernard.

Tip 2: “To infer meaning to the terms would be to code in error. So, I recommend that the provider be queried for a more definitive diagnosis if you believe the provider may be able to provide one,” Bernard concludes.