Pediatric Coding Alert

Find guidance on selecting the correct dermatitis codes.

As medical coders, you understand that accuracy is important. You also understand how important it is to code encounters and diagnoses based on the doctor’s notes. Sometimes though, the terms the doctor uses in the notes don’t match the code descriptors, which can make selecting the correct codes a challenge.

Confusion like this is common. To help you out, we’re going to take a look at common pediatric skin ailments and refresh your understanding on how to best use the ICD-10 code book and find the most accurate codes.

Check Out these Chickenpox Codes

Let’s say the encounter notes indicate the physician diagnosed and treated “cx pox w/o complication.” It’s easy enough to understand this means “chickenpox without complication,” but there aren’t any codes for “chickenpox.”

Check the index: This is where you have to remember the ICD-10 alphabetic index instructs you to search for the term: “Varicella.” Varicella is another term for chickenpox, since the condition is caused by the varicella-zoster virus (VZV). From there, you can follow the trail to a host of chickenpox codes:

• B01.0 (Varicella meningitis)
• B01.11 (Varicella encephalitis and encephalomyelitis)
• B01.12 (Varicella myelitis)
• B01.2 (Varicella pneumonia)
• B01.81 (Varicella keratitis)
• B01.89 (Other varicella complications)
• B01.9 (Varicella without complication)

So, for this case, you’ll report B01.9 for chickenpox without complications.

Note: Before reporting the diagnosis code for chickenpox, make sure the physician has officially diagnosed it. Chickenpox is characterized by small red bumps, commonly referred to as vesicles or blisters, that are filled with fluid and eventually break, leak, then crust over. Clusters of them resemble a rash. These symptoms can indicate a variety of skin conditions depending on the stage

of development. For example, impetigo, coded to L01.- (Impetigo), commonly features a rash consisting of blisters, usually on the extremities or face. These blisters eventually burst, become infected, and the pus hardens and crusts over.

Keep Coxsackievirus in Mind

This is another condition whose descriptors indicate the virus that causes them rather than the name of the disease itself. Caused by an enterovirus, coxsackievirus 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. For this reason, this condition is often known colloquially as hand, foot, and mouth disease.

Check the index: If the pediatrician diagnoses a patient with “hand, foot, and mouth disease,” be careful how you search the alphabetic index. Searching by the first word, “hand,” you get “hand-foot syndrome,” and instruction to see L27.1 (Localized skin eruption due to drugs and medicaments taken internally), which is not the correct code for coxsackie virus. When you look under “disease,” you will find the correct code, however, which is B08.4 (Enteroviral vesicular stomatitis with exanthem).

Note: As always, pay close attention to the details in the medical record. You will report B08.4 when the patient has hand, foot, and mouth disease caused by the coxsackievirus. This code refers to the disease that presents as described above. However, you’ll report B34.1 (Enterovirus infection, unspecified) when the patient has a confirmed coxsackievirus infection but the specific presentation is not specified in the medical record.

Stay On Top of Dermatitis

Similar to coxsackievirus, the unspecified codes are going to be common but also confusing when it comes to atopic dermatitis.

Check the index: When you search under “dermatitis,” you’ll see an overwhelming number of codes to sift through. When you look critically, though, you’ll see that most dermatitis codes fall between L20 (Atopic dermatitis) and L30 (Other and unspecified dermatitis). Once again, you’ll need to depend on the details in the medical record to help you narrow down your search. For example, if you’re dealing with atopic dermatitis, the index points to L20.9 (Atopic dermatitis, unspecified). A closer look in the tabular list shows you more of the L20- family, and from there you can select the correct code.

Trouble 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, not 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: Keep in mind that dermatitis codes lurk other places as well, not just between the L20 and L30 categories. 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 common terms 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 for eczema.