Primary Care Coding Alert

Question: I work for primary care providers at a family practice, and one of our providers saw a 4-year-old established patient who presented with two large red and blackish blotches on the bottom of their toe and sole of their foot. The documentation says that the spots didn’t blanch when pressed and weren’t swollen, and the patient did not complain of any pain or itchiness when the spots were pressed or otherwise. The provider described this as a “purpura rash” but listed “lichen aureus” as the diagnosis. The codes for these conditions are in completely different code families. Do I need to query the provider for more information?

Illinois Subscriber

Answer: Purpura can manifest as splotchy patches due to bleeding under the skin. Purpura can be nonthrombocytopenic, indicating a normal level of platelets, or thrombocytopenic, indicating low levels of platelets.

The ICD-10-CM parent code for purpura, D69.- (Purpura and other hemorrhagic conditions), encompasses many specific, named conditions.

According to AAPC’s Codify, the ICD-10-CM code for lichen aureus can be found in the L28- (Lichen simplex chronicus and prurigo) subcategory.

With the documentation you have available, you may not have information to choose the most accurate ICD-10-CM code, because purpura may result from bleeding under the skin and lichen conditions may affect the skin directly, with the formation of papules or plaques.

With the information you have available, you could indeed query the provider for clarification so you can choose an accurate ICD-10-CM code to signify the patient’s condition.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC