Pediatric Coding Alert

Hint: Some rashes may be specific to newborns.

Pediatric rashes can develop for various reasons and frequently display character differences. Contracting a rash can result from a patient trying new food, having been exposed to an illness or virus, dry skin, or even contact with a pet. It is important to note that dermatitis is a term for any condition that causes skin inflammation.

In this article, we will go over some of the different types of rashes, the characteristics of each, as well as different medications, procedures, and laboratory testing used to treat them. Look for articles over the coming months that focus more specifically on rashes with viral, bacterial, or fungal causes, too.

Check Out These Types of Rashes in Pediatric Patients

Most rashes in pediatric patients can be diagnosed during the history and physical. Some rashes occur due to a serious illness but typically also have systemic manifestations of the disease.

Dermatitis is any condition that causes skin inflammation. Looking up dermatitis in the Alphabetic Index of the ICD-10-CM code book will lead you L30.9 (Dermatitis, unspecified) and then dozens of options to further specify your diagnosis coding. Here are some conditions that fall under the umbrella of dermatitis:

• Atopic dermatitis, which is also known as eczema, is an ongoing problem that causes dry, red, itchy skin. Children with eczema have more sensitive skin than other individuals. Look for ICD-10-CM codes in the L20- (Atopic dermatitis) code family.
• Diaper dermatitis is irritant contact dermatitis; it is also known as “nappy rash” in other countries. The skin is compromised by two major factors: increased moisture in the occlusive environment of the diaper, and urine and fecal waste causing a breakdown of the skin’s moisture barrier. This can also lead to increased fungal infection, causing Candidal diaper rash. Approximately 25 percent of babies who wear disposable diapers and about 50 percent of babies who wear traditional cloth nappies will experience diaper rash. This rash can be itchy, uncomfortable, and painful. Look to L22 (Diaper dermatitis) for this diagnosis.

Milia, commonly known as milk spots or an oil seed, are small, white cysts on the skin. The cysts are filled pockets under the surface of the skin, and most likely are found on the face but can also be on the upper arms and upper abdomen. These are usually asymptomatic and can sometimes be itchy. They typically disappear on their own after a few weeks.

Erythema toxicum (ENT) is a rash that is very common among newborns. Red patches or small, fluid-filled bumps (pustules) will form just a few days after birth and fade within a week. It can be found on the face, chest, arms, and legs, but does not present on the palms or soles of the feet. ENT is not dangerous, painful or uncomfortable, and there are no long-term effects. Look to code P83- (Other conditions of integument specific to newborn) for this condition.

Baby acne is another common skin condition affecting about 20 percent of newborns and is typically caused by maternal hormones. This will go away on its own within a few weeks or months. Traditional remedies include usng a gentle cleansing product, cleansing the area with warm water two times a day, and patting skin dry gently. The diagnosis code for this is L70.4 (Infantile acne).

Cradle cap presents as crusty or oily, scaly patches on the scalp. It is not painful or itchy. These white or yellow scales are not easy to remove. It typically resolves on its own in weeks or a few months. One home care measure is washing the scalp daily with a mild shampoo, making sure not to scratch the affected areas. Look to L21.0 (Cradle cap) to report this diagnosis.

Beware of These Rashes of Environmental Origin

Environmental rash is an immune response to normally harmless substances. These can include pollen, dust, mold, or pet dander.

Heat rash, or prickly heat, presents as tiny red bumps or tiny fluid-filled blisters. This is commonly seen during periods of high heat and humidity. The affected areas might be the upper chest and back, the neck fold, around the hairline, or under the diaper, but can be found anywhere on the body. It can be itchy. Taking measures to reduce the time in prolonged heat settings or where there is high humidity will help reduce the chance of getting a heat rash.

Poison ivy appears as a red, itchy rash that can blister and spread. It is contagious if the oil from the plant is transferred to other areas of the body or to others. Recognizing it early to provide treatment is key. Treatment should start with gently washing the affected area with soap and cool water to remove any remaining oil. Avoid scratching, as this can lead to infection. Over-the-counter calamine lotion can be used following directions to soothe the itching, and using cool compresses can provide relief. You can report poison ivy (or poison oak or sumac, which may also manifest as rashes) with L23.7 (Allergic contact dermatitis due to plants, except food).

Insect bites can manifest in the form of a simple skin reaction and are commonly caused by organisms of phylum Arthropoda. These are easily treatable with an antihistamine or topical corticosteroid that can be found over the counter. Insects act as vectors to transmit micro-organisms that cause different systemic diseases. These systemic diseases can be treated conservatively or with different medications depending on the microorganism that was transmitted by the insect. You might report a nonvenomous insect bite with a code from W57- (Bitten or stung by nonvenomous insect and other nonvenomous arthropods) code set.

Swimmer’s itch is a temporary allergic reaction caused by a parasite that dies once it passes into the skin. For children that wade into water, the rash may occur only on the legs. For swimmers, this can occur all over the body. This rash is itchy, but no specific medicine is needed.

Folliculitis (hot tub) is caused after contact with water that contains the bacteria Pseudomonas aeruginosa. It is an infection found on the skin surrounding hair follicles. This bacterium is found in warm, wet areas like whirlpools, hot tubs, and water slides. This rash is notably contagious and irritating and enters through the hair follicles or abrasions in the skin. Mild cases usually clear up in a few days on their own without treatment, although systemic conditions may occur such as malaise, fever, and fatigue. The diagnosis code for this condition is L73.9 (Follicular disorder, unspecified).

Sharonn Johnson, CPC, Senior Manager,
CCR Services at Pinnacle Enterprise Risk Consulting Services