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Dermatology Patient Encounter

A solo Family Medicine physician received a telephone call from the mother of a 15 year old female patient in general good health regarding a new pruritic rash on her hands, arms, and legs, which had started 5 days earlier and was described as “hives.” During the call, the Family Medicine physician advised the patient to take OTC cetirizine daily, ranitidine daily, and diphenhydramine, as needed, nightly. The patient denied any contact with new chemicals, cosmetics, plants, insects, or food. She also denied any past history of similar rashes, asthma, atopy, or eczema. No other members of the patient’s family experienced symptoms.

Two days later, after no improvement, the Family Medicine Physician saw the patient in her office. Upon physical examination, the patient still had a pruritic, erythematous, papular rash located on the flexural areas of both wrists and elbows as well as behind her knees. The physician prescribed triamcinolone acetonide cream, 1%, and advised the patient to apply it 2-3 times a day for a maximum of 14 days, in addition to using a moisturizing cream. The patient’s atopic dermatitis resolved completely after just one week. The physician’s final diagnosis for this case would be coded in ICD-9 as atopic dermatitis.

Coding: ICD-9 to ICD-10

In ICD-9-CM, the patient’s condition currently maps to 691.8, Other atopic dermatitis and related conditions, a more general code that includes related conditions like eczema (atopic, flexural, and intrinsic), Besnier’s, and neurodermatitis. In ICD-10-CM, this patient’s condition maps to the specific different types, and in this patient, it would be code L20.82, Flexural eczema.

Greater specificity is afforded in ICD-10, where the code specifically indicates eczema, the type of eczema, and will allow the physician to capture and communicate greater detail about this patient’s exact condition. ICD-10 provides specific codes for each of the conditions that are currently captured in the general ICD-9 code as illustrated in the table below.

Overall, in ICD-9-CM, many dermatologic conditions and commonly seen rashes are lumped into a few, broad diagnosis codes. ICD-10 will enable providers to perform more targeted case studies and reviews, and improve overall quality of care.

eHealth Connection

The ability of ICD-10-CM to capture more data in terms of depth and specificity helps providers to recognize differences in the risk, severity, and complexity of each case. This is of particular importance as our healthcare system moves towards value based healthcare. Better identification and documentation of the complexity of a patient’s condition enables greater data collection of the specific care rendered to a patient. From this data comes the ability to demonstrate the true value of the care physicians provide to their patient populations.

Comparison of Current ICD-9 Code and Illustrative ICD-10 Codes

ICD-9-CM

691.8 Atopic dermatitis

ICD-10-CM

Correct Code:

L20.82 Flexural eczema

Other Illustrative ICD-10 Codes That Map to the Current ICD-9 Code:

L20.0 Besnier’s prurigo

L20.81 Atopic neurodermatitis

L20.84 Intrinsic (allergic) eczema

L20.89 Other atopic dermatitis

L20.9 Atopic dermatitis, unspecified