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Dermatology Billing Services and ICD-10 Coding

January 14, 2013

Dermatology Billing ServiceThe transition from ICD-9-CM to ICD-10-CM will revolutionize the dermatology billing field. The diagnosis information reported on healthcare claims will be required to be more specific. The current coding system contains approximately 17,000 codes for dermatology billers. ICD-10-CM contains approximately 68,000 diagnosis codes used in outpatient billing. Not only will the nature of the information contained in a clean healthcare claim change, so will the documentation requirements to support submitted codes.

The basics of assigning diagnosis codes based on the medical record will not change. What will change is that the specificity of reported data will be more granular. The codes in ICD-10-CM will more closely match the contents of the medical record. There is expected to be a decrease in unspecified codes on healthcare claims.  This should reduce denials for services currently considered medically unnecessary due to quirks in the ICD-9 system. When ICD-10-CM codes are applied correctly, cash flow should be further streamlined with reduced need to provide supporting documentation or to file appeals.

This is particularly important to a dermatology practice that regularly performs procedures than can be performed for either cosmetic or therapeutic purposes. The diagnosis codes that are in ICD-10-CM are designed to provide maximum information to  third-party payers.  The new codes should clearly indicate whether a procedure was performed to improve a patient’s health rather than their appearance.  

The implementation of ICD-10 coding standards to dermatology claims will require some rethinking of how to approach the tabular listings of codes. Chapter 12 is the section of ICD-10-CM that describes diseases of the skin and subcutaneous tissues. This chapter does not include skin neoplasms that are found in Chapter 2, or superficial injuries, which are found in Chapter 19. 

Chapter twelve of ICD-9-CM, which also deals with skin diseases is broken into three subchapters. ICD-10-CM breaks its listings of skin disorders into nine subchapters –

  1. Infections of the skin and subcutaneous tissue
  2. Bullous disorders
  3. Dermatitis and eczema
  4. Papulosquamous disorders
  5. Urticaria and erythema
  6. Radiation-related disorders of the skin and subcutaneous tissue
  7. Disorders of skin appendages
  8. Intraoperative and postprocedural complications of the skin and subcutaneous tissue
  9. Other disorders of the skin and subcutaneous tissue

This is a far cry from the more vague divisions found in ICD-9-CM, which group skin disorders under the headings of infections, other inflammatory conditions, and other diseases of the skin and subcutaneous tissue. 

As the organization of ICD-10-CM indicates, greater specificity will be required by the new dermatology coding system. The proof is in the individual codes themselves.  In ICD-9-CM, the code 680 is used to describe a carbuncle and furuncle regardless of the carbuncle’s clinical presentation. An additional digit is required to submit a dermatology claim for a carbuncle, and these additional digits indicate anatomical site in a general way. For instance, 680.2 is used to report a carbuncle on the patient’s trunk.

In ICD-10-CM, there is a greatly expanded set of possible codes based on the state of the carbuncle. The L02 the code used to describe Cutaneous abscess, furuncle, carbuncle.  Like the current coding system, ICD-10-CM requires greater specificity through the use of additional digits to indicate anatomical site. L02.2 describes an abscess, furuncle, or carbuncle of the trunk. If the carbuncle has ruptured, it is more accurately coded L02.21, Cutaneous abscess of trunk, but additional digits are still required to submit a clean dermatology claim.  ICD-10-CM requires that open skin abscesses be specifically located for accurate reporting purposes. L02.211 is a cutaneous abscess of the abdominal wall, while L02.212 is a cutaneous abscess of the any part of the back except the buttock.  

As with ICD-9-CM, every digit of an ICD-10-CM code contains specific information that needs to be documented in the medical record. The difference between the two coding systems is that ICD-10 will more clearly report the patient’s medical condition at the time of treatment.  


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