Pediatric Coding Alert

Itching to code rashes correctly? This guide has you covered.

Skin rashes in children are particularly common during the summertime. Not only can the summer heat itself cause skin irritation, but kids spend more time outdoors during the summer months. That means playing in and around vegetation and water, which can cause plenty of nasty skin conditions as well.

So, if your waiting room is standing room only this summer, this guide will help save you some time when you have to code five of the most common warm-weather skin rashes.

Heat Rash

This condition, which is very common in younger children, occurs under clothing or in areas of the body where the skin is prone to heating up, such as the creased areas behind the knees or elbows. When the patient cannot perspire and dissipate heat effectively due to blocked pores, small bumps called papules appear on the skin and form a rash.

Synonym: Prickly heat. Miliaria.

How It’s Coded: The milaria synonym tells you that the correct code for heat rash is L74.0 (Miliaria rubra).

Plant Rashes

A number of plants, such as poison ivy, poison oak, sumac, and wild parsnip, contain chemicals that create an allergic skin reaction when they are touched. The affected area will turn red and swollen, and blisters will also form.

How They’re Coded: ICD-10 does not distinguish between types of plants, so you will use either L23.7 (Allergic contact dermatitis due to plants, except food), L24.7 (Irritant contact dermatitis due to plants, except food), or L25.5 (Unspecified contact dermatitis due to plants, except food).

Coding Alert: To determine which code to use, you will need to see if your provider has noted whether the rash is localized to one specific area of the patient’s skin or whether it has spread. “If the rash has spread and is now causing significant issues, such as infections on the skin, then you would use L23.7, the code for allergic contact. Also, if the origin of the rash cannot be assessed, you would use L25.5, the unspecified code,” explains Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pennsylvania.

Cocksackie Virus

While you may think of viral conditions as typical of winter months, this condition, caused by an enterovirus, mostly flares up in the summer. The virus starts with symptoms that are similar to the common cold, but it then produces tiny blisters. This rash can appear in the mouth, the palms of the hands, the soles of the feet, and on the buttocks.

Synonym: Hand, foot, and mouth disease.

How It’s Coded: The synonym helps you zero in on B08.4 (Enteroviral vesicular stomatitis with exanthem).

Insect Bites and Stings

For most children, stings and bites generally cause itching and mild discomfort. But for some children, they can cause anaphylactic shock, which can range in severity from a rash or hives through to a potentially life-threatening closure of the airways.

Bites from mosquitos and ticks can also produce rashes that are symptomatic of other dangerous conditions such as Rocky Mountain spotted fever and Lyme disease.

How They’re Coded: This is tricky, as “you need to keep in mind that there are over 350 diagnoses that could relate based on site and care,” says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/ coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. “The seventh digits, A [Initial encounter], D [Subsequent encounter], and S [Sequela], will also play a role in each case,” Johnson adds.

For rashes caused by nonvenomous insect bites: First, code the condition associated with the bite, such as A77.0 (Spotted fever due to Rickettsia rickettsii) for Rocky Mountain spotted fever and A69.2- (Lyme disease) for Lyme disease. Then you will use W57.XX (Bitten or stung by nonvenomous insect and other nonvenomous arthropods) for the bite, using the appropriate seventh character to document the encounter.

For rashes caused by bee stings and other venomous animal or insect bites: Again, you’ll code the condition first — in this case, anaphylactic shock using T78.2XX- (Anaphylactic shock, unspecified), adding the appropriate seventh character to document the encounter. Then you will use T63.4- (Toxic effect of venom of other arthropods), adding the appropriate fifth digit for the kind of insect, the appropriate sixth digit to indicate intentionality, and the appropriate seventh character again to document the encounter. And this time, you will add an encounter code from Z91.03- (Insect allergy status) to indicate the anaphylaxis.

Swimmer’s Itch

Caused by parasites that inhabit warm, shallow water, this condition produces a rash comprised of small, raised bumps, and possibly even welts or blisters, on areas of the skin that have not been covered.

Synonyms: Clam digger’s itch. Cercarial dermatitis.

How It’s Coded: ICD-10 lists this rash under its more formal name: B65.3 (Cercarial dermatitis).