|
|
For other articles and previous issues click here. March 8, 2004 Coding
for Eczema Eczema, which describes certain types of dermatitis, is a skin inflammation that affects all age groups. Characterized by itching, small blisters with oozing, and thickened and scaly skin, eczema is a common, non–life-threatening, and noncontagious chronic skin disorder. In the early stages, eczema can be red, blistering, or oozing, while late eczema is scaly, brownish, or thickened. Types of Eczema Contact dermatitis occurs after direct contact to an allergen such as metals or an irritant such as skin soap. It develops when the body’s immune system reacts against a substance in contact with the skin. Symptoms include redness, itching, blisters, and weeping sores of areas that were in contact with either the allergen or irritant. For coding purposes, the word contact is a nonessential modifier for dermatitis. Therefore, the specific code assignment will depend on the causative agent as discussed below. Irritant contact dermatitis is caused by frequent contact with everyday substances. Common irritants include laundry soap or detergent (692.0); skin soap (692.0); cleaning products (692.4); and solvents (692.2). Allergic contact dermatitis develops over a period of time through repeated contact with the substance. Common allergens include rubber (692.4); metals, such as nickel (692.83); jewelry (692.83); cosmetics (692.81); hair dyes (692.89); poison ivy, poison oak, poison sumac (692.6); foods in contact with the skin, such as meat, milk, or fruit (692.5); and topical drugs, such as antibiotics or anesthetics or Neomycin (692.3). If the food or drug was taken internally and caused dermatitis, assign code 693.1 or 693.0, respectively. If an allergic reaction occurred due to a drug, it must be determined whether or not the drug was administered and taken correctly by the proper patient. If the drug was not administered or taken correctly by the proper patient, code the condition as a poisoning. In cases of poisoning, the drug poison code is sequenced first. These codes are located in the first column of the Table of Drugs and Chemicals in AHA Coding Clinic for ICD-9-CM. An E code from one of the other columns should be selected to identify the circumstances surrounding the poisoning. It should be noted that an E code from the column labeled “Therapeutic Use” is never used with the code from the first column labeled “Poisoning.” The manifestation (ie, dermatitis) of the poison is sequenced after the poisoning code. However, some patients develop an allergic reaction to the drug even though it was administered and taken correctly. This is called an adverse effect. In the case of an adverse effect, the manifestation is sequenced first followed by an E code from the column labeled “Therapeutic Use” in the Table of Drugs and Chemicals. The E codes in this column are used only when a patient has an adverse reaction to a drug that was taken and given properly. The E code to identify the drug involved is mandatory in ICD-9-CM coding. If there is no mention of the drug having been taken incorrectly, it is assumed that the drug reaction is an adverse effect. Neurodermatitis occurs because of repeated scratching, which causes patches of thickened, brownish skin with definite margins that are thick and leatherlike. Tight garments that rub or scratch the skin may cause it. Neurodermatitis, which is also called lichen simplex chronicus, is classified to code 698.3. If the neurodermatitis is documented as atopic neurodermatitis, assign code 691.8. Seborrheic dermatitis is characterized by greasy, scaling areas on the scalp, at the sides of the nose, between the eyes, behind the ears, on the external ear canal, or over the breastbone. The symptoms include oily (greasy) areas of skin, white or yellowish flaking, itching, and mild redness. Seborrheic dermatitis, which is classified to code 690.1x, includes cradle cap and dandruff. Cradle cap (690.11) is thick, crusty, yellow, scaly skin on a baby’s scalp. If a baby develops seborrheic dermatitis that is not on the scalp, assign code 690.12. Dandruff (690.18) is excessive dryness that can be due to mild seborrheic dermatitis, psoriasis, and other skin disorders. Stasis dermatitis occurs when fluid accumulates in the tissues just beneath the skin. It often occurs with varicose veins, which causes the fluid build-ups. Stasis dermatitis causes the skin at the ankles and over the shins to become discolored (red or brown), thick, and itchy. Open sores or ulcers may also develop. Stasis dermatitis is classified to code 459.81. Stasis dermatitis with varicose veins is classified to code 454.1. If ulcers are present, assign code 454.2. (AHA Coding Clinic for ICD-9-CM, 1991, second quarter, page 20.) Treatment involves treating the condition that caused the fluid to accumulate in the ankles. Perioral dermatitis (695.3) affects the area around the mouth, causing small red bumps, pus-filled bumps, or mild peeling. Mainly affecting young women, perioral dermatitis behaves and looks like acne and is treated with oral antibiotics such as tetracycline and a mild corticosteroid cream. Complications Coding and sequencing for eczema are dependent upon the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey Howard, RHIA, of 3M Health Information Systems (800-367-2447), a leading supplier of coding and classification systems to nearly 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. |
 |
 |