Mary Jo Bowie MS, BS, AAS, RHIA, RHIT

Diseases of the Skin and Subcutaneous Tissue CHAPTER 17 Diseases of the Skin and Subcutaneous Tissue

Diseases of the Skin and Subcutaneous Tissue—Code Range L00-L99 Diseases of the skin and subcutaneous tissue are reported from Chapter 12 of ICD-10-CM. This chapter contains codes for diseases of the skin and subcutaneous tissue as well as the nails, sweat glands, hair, and hair follicles. This system is also known as the integumentary system.

Three Layers of the Skin The skin is specialized tissue made up of three layers. Epidermis—Outermost layer Dermis—Thick layer below the epidermis Subcutaneous layer—Connects to the muscle surface and connects the fat cells

Cross Section of the Skin © Cengage Learning 2014

Infections of the Skin and Subcutaneous Tissue—L00-L08 This block of codes reports: Impetigo Cutaneous abscess, furuncle, and carbuncle Cellulitis and acute lymphangitis Many of the codes are site specific, and an instructional notation appears at the start of the block that indicates that an additional code should be added to identify the infectious agent.

Bullous Disorders—L10-L14 There are four categories in this block: L10—Pemphigus L11—Other acantholytic disorders L12—Pemphigoid L13—Other bullous disorders L14- Bullous disorders in disease classified elsewhere

Dermatitis and Eczema—L20-L30 In this block of codes, the terms dermatitis and eczema are used interchangeably. The various types of dermatitis are: Atophic Seborrheic Diaper Allergic contact, irritant contact Exfoliative Dermatitis due to substances taken internally

Codes L20-L30 (cont.) Also within this block are codes for: Lichen simplex chronicus and prurigo Pruritus Other and unspecified dermatitis, such as nummular and infective dermatitis

Papulosquamous Disorders—L40-L45 These categories report: Psoriasis- L40 Parapsoriasis- L41 Pityriasis rosea- L42 Lichen planus- L43 Other papulosquamous disorders- L44 and L45

Urticaria and Erythema—L50-L54 These categories report: Urticaria- L50 Erythema multiforme- L51 Erythema nodosum- L52 Other erythematous conditions such as toxic erythema and chronic conditions- L53 Erythema in diseases classified elsewhere-L54

Radiation-Related Disorders of the Skin and Subcutaneous Tissue—L55-L59 This block reports: Sunburn: according to the degree of burn Skin changes due to ultraviolent radiation Skin changes due to chronic exposure to nonionizing radiation Radiodermatitis Other disorders related to radiation It should be noted that many of these codes contain an instructional notation to use an additional code.

Disorders of Skin Appendages—L60-L75 This block reports: Nail disorders- L60 Alopecia- L61 and L64 Nonscarring and scarring hair loss- L65 and L66 Hair color and hair shaft abnormalities- L67 Hypertrichosis- L68 Acne- L70 Rosacea- L71 Follicular cysts of skin and subcutaneous tissue- L72 Other follicular disorders- L73 Sweat disorders- L74 and L75

Intraoperative and Postprocedural Complications of Skin and Subcutaneous Tissue—L76 This block includes complications that occur after an operation or procedure. The code descriptions need to be closely read for detail.

Other Disorders of the Skin and Subcutaneous Tissue—L80-L99 This block includes: Vitiligo Disorders of pigmentation Seborrheic keratosis Corns and callosities Epidermal thickening Keratoderma in diseases classified elsewhere Transepidermal elimination disorders Pressure ulcers and nonpressure chronic ulcers

Pressure Ulcers Pressure ulcers are also known as decubitus ulcers, bedsores, or pressure sores. ICD-10-CM defines the stages of ulceration in stages I to IV. The site and stage of the ulceration must be known for proper code assignment.

Decubitus Ulcer Sties of Bed-bound Patient © Cengage Learning 2014

Decubitus Ulcer Sites of Wheelchair-bound Patient © Cengage Learning 2014

Official ICD-10-CM Guidelines for Coding and Reporting The Official Guidelines address: Pressure Ulcer Stage Codes Pressure ulcer stages Unstageable pressure ulcers Documented pressure ulcer stage

Official ICD-10-CM Guidelines for Coding and Reporting Continued Patients admitted with pressure ulcers documented as healed Patients admitted with pressure ulcers documented as healing Patients admitted with pressure ulcers evolving into another stage during the admission.

Coding Practice Select the code for the following: Subcutanous cellulitis of the right finger

Coding Practice Solution Main term to reference in index: Cellulitis Modifying term: Finger, (subcutaneous) Code Assignment: L03.011