Primary Care Coding Alert

Question: Our provider documented a patient with “a rash consistent with livedo reticularis.” Is this sufficient to document L95.0, or does this fall under the category of a questionable diagnosis that needs to be coded using a signs and symptoms code?

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Answer: Unlike the coding guidelines for “short-term, acute care, long-term care and psychiatric hospitals,” guidelines for outpatient services do not allow you to report a diagnosis that is “consistent with” a certain condition as a definitive diagnosis. Per Section IV.H of the ICD-10 Official Guidelines, you should “not code diagnoses documented as ‘probable,’ ‘suspected,’ ‘questionable,’ ‘rule out,’ or ‘working diagnosis’ or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.”

While it is not one of the phrases listed in the guidelines, your provider’s language in this encounter indicates uncertainty, so you should not document L95.0 (Livedoid vasculitis). Instead, you should use a sign and symptoms code consistent with the provider’s description of the condition such as R21 (Rash and other nonspecific skin eruption).