ED Coding and Reimbursement Alert
Check This Guide to Skin Rash Coding
Hint: Rashes impact both adults and children, but many codes remain the same. When a rash comes on suddenly, people often report directly to the ED — particularly if they’re concerned about having an allergic reaction to something. Fortunately, the vast majority of rashes that ED providers see are considered minor. Even if they aren’t serious, however, you need to understand which codes apply, and which terms you might see in a chart. To understand how to code common rashes, check out this quick guide. Can You Code Roseola Infantum? When patients present with a fever followed by a rash similar to measles, they may be particularly concerned, especially since this condition almost exclusively affects children under the age of 2. However, roseola infantum (also called exanthema subitem or sixth disease) typically spreads peripherally from the trunk, giving it a distinctive appearance from most other conditions. How is it coded? To code this condition correctly, you’ll turn to the B08.2- (Exanthema subitum (sixth disease)) codes, all of which apply to the synonym roseola infantum. Hot tip: You’ll need to add a 5th character to specify the infectious agent causing the condition. If your provider does not specify the agent, you’ll use B08.20 (Exanthema subitum (sixth disease), unspecified), the unspecified roseola infantum code. But testing may reveal the roseola has been caused by human herpesvirus 6, its most common cause. In this case, you’ll code B08.21 (Exanthema subitum (sixth disease) due to human herpesvirus 6). Check L42 Series for Pityriasis Rosea Typically affecting children and young adults, pityriasis rosea usually starts as a single lesion, often referred to as a herald patch, on the trunk. The patch is usually rose-hued and shaped like an oval. How is it coded? Simply assign L42 (Pityriasis rosea) to this diagnosis. Watch Related Conditions With Scarlet Fever A scarlet fever rash spreads from the upper trunk to the rest of the body after the patient first develops a fever and sore throat. Although this condition affects children more frequently, people of any age can (and do) get scarlet fever. How is it coded? You will use a code from the A38.- (Scarlet fever) series. Hot tip: The A38.- codes are combination codes, so if your provider documents scarlet fever with another related condition, you could use one of the following: And if your ED physician does not document a related condition, you’ll report A38.9 (Scarlet fever, uncomplicated). Understand Impetigo An impetigo rash takes the form of blisters, usually on the extremities or face. The blisters eventually burst and become infected, usually creating pus that hardens to form a yellow crust. When people get this type of rash, they often fear infection and head to the ED. Like scarlet fever, this condition is seen more commonly among children, but people of any age can develop impetigo. How is it coded? You’ll find the impetigo codes in the L01.- (Impetigo) group. Hot tip: Most impetigo is of the nonbullous, or crusted, type, coded to L01.01 (Non-bullous impetigo). Check B08 Series for Erythema Infectiosum The rash associated with erythema infectiosum (also called fifth disease or slap cheek syndrome) looks like the patient’s face has been slapped. The rash usually follows a few days after the patient develops a general malaise and a low-grade fever. Although this condition can affect adults, it’s almost exclusively seen among children. How is it coded? Again, code assignment for this diagnosis is simple, and you will only need to use B08.3 (Erythema infectiosum (fifth disease)). The Final Word “The biggest problem I see is lack of detail from providers to code more specifically,” notes Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions in Holcombe, Wisconsin. “That’s because providers often only have enough information to document the symptoms of the skin problem, such as rash [R21], hives [L50.9], or skin inflammation [L08.9] rather than providing a more definitive diagnosis,” adds Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P, author of the AMA book, Risk Adjustment Documentation and Coding. “Ultimately, you should query the provider for a more definitive diagnosis if you believe the provider may be able to provide one,” Bernard concludes.
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