Pediatric Coding Alert

Don’t dig too deep for these common integumentary diagnoses.

“There are more than 12 million office visits annually for rashes and other skin concerns in children and adolescents, of which 68 percent are made to primary care physicians,” according to the American Family Physician (www.aafp.org/afp/2015/0801/p211.html). The article goes on to identify eight of the most common skin conditions affecting children and adolescents.

As your skin condition coding knowledge is constantly being put to the test, we’ve put together this guide to help you identify the precise ICD-10 code the next time your pediatrician encounters a patient with a rash. And we’ve included some great tips for precision documentation.

1) Roseola infantum (exanthema subitum)

How is characterized? Patients present with a fever followed by a rash similar to measles, but which spreads peripherally from the trunk.

How is it coded? To code this condition correctly, you’ll turn to the B08.2- (Exanthema subitum [sixth disease]) codes, all of which have the synonym roseola infantum.

Hot tip: You’ll need to add a 5^th character to specify the infectious agent causing the condition. If your pediatrician does not specify the agent, you’ll use B08.20 (Exanthema subitum [sixth disease], unspecified), the unspecified roseola infantum code. But testing may reveal the roseola has been caused by human herpesvirus 6, its most common cause according to the American Family Physician. In this case, you’ll code B08.21 (Exanthema subitum [sixth disease] due to human herpesvirus 6).

2) Pityriasis rosea

How is characterized? Most often, patients present with a single lesion, often referred to as a herald patch, on the trunk. The patch is usually rose-hued and shaped like an oval.

How is it coded? Simply assign L42 (Pityriasis rosea).

3) Scarlet fever

How is characterized? The rash spreads from the upper trunk to the rest of the body after the child first develops a fever and sore throat.

How is it coded? You will use a code from A38.- (Scarlet fever).

Hot tip: The A38.- codes are combination codes, so if your pediatrician documents scarlet fever with another related condition, you could use one of the following:

• A38.0 (Scarlet fever with otitis media)
• A38.1 (Scarlet fever with myocarditis)
• A38.8 (Scarlet fever with other complications)

And if your pediatrician does not document a related condition, you’ll A38.9 (Scarlet fever, uncomplicated). 

4) Impetigo

How is characterized? The rash 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.

How is it coded? You’ll find the impetigo codes in the L01.- (Impetigo) group.

Hot tip: Most impetigo is of the nonbullous, or crusted, type, coded to L01.01 (Non-bullous impetigo)

5) Erythema infectiosum

How is characterized? The rash associated with this infection 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.

How is it coded? Again, code assignment for this diagnosis is simple, and you will only need to use B08.3 (Erythema infectiosum [fifth disease]).

6) Molluscum contagiosum

How is characterized? Like impetigo, this rash takes the form of tiny, pearlescent skin-colored blisters that appear in small groups around the body.

How is it coded? Simply use B08.1 (Molluscum contagiosum).

7) Tinea infection

How is characterized? This condition is easily identified by its circular patches with scaly borders and a hollow center, which are most commonly referred to as ringworm.

How is it coded? You’ll find all the codes you need for tinea infections in the B35 (Dermatophytosis) group.

Hot tip: The tinea codes are differentiated by location, so use the following chart to find the precise code associated with the area of the patient’s body affected by the rash:

8) Atopic dermatitis

How is characterized? This skin condition can present in several different ways, including lesions, blisters, scaley and even dry skin.

How is it coded? This is probably the most difficult of all skin conditions to code because some pediatricians may use the term atopic dermatitis as a synonym for eczema. Nominally, 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, and you will have to verify with your pediatrician whether a code from L30.- (Other and unspecified dermatitis) is more appropriate.

The Final Word

“The biggest problem I see is lack of detail from providers to code more specifically,” notes Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions in Holcombe, Wisconsin. “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.

“Ultimately, you should query the provider for a more definitive diagnosis if you believe the provider may be able to provide one,” Bernard concludes.