Smooth Over These Common Skin Conditions
Know payer policies to prevent issues with cosmetic procedure coverage. Recent studies have shown that nearly 80 percent of people will experience acne during their lifetime, most during their early teen years. Based on this statistic, it’s safe to assume encounters for this reason will be common in your office. Acne cases present coding challenges, such as supporting your pediatrician’s notes with the correct diagnosis code and selecting the precise procedure code for the treatment that was provided. To assess your understanding of acne treatment coding, we've prepared two scenarios for you to review. Scenario 1 A 13-year-old patient reports to your provider describing sensitive facial acne with pustules. The pediatrician also notes the presence of several open and closed comedones and papules on the patient's cheeks, forehead, and chin. After the examination, the pediatrician decides to proceed with treatment for the condition. Diagnose the Condition You’ll want to begin by focusing on the L70.- (Acne) section of your ICD-10 manual. Although you may not know the specific conditions each one of these codes documents, you can already rule out two of them — L70.1 (Acne conglobate) and L70.2 (Acne varioliform) — immediately as they are extremely rare forms of the condition, and you can also rule out L70.4 (Infantile acne), as the note states that the patient is a teenager. Instead, you’ll want to focus your attention on the following codes: The major differences between the above codes are as follows: L70.0, the most common acne condition seen in teens and young adults, is due to clogged hair follicles. L70.3 is a severe type of acne with painful cysts and nodules that can cause abscesses and scarring, and is worsened by hot, humid weather. Code L70.5 is a type of acne linked to a mental condition causing an irresistible urge to squeeze and pick at pimples in pursuit of “perfect” skin. Make note: L70.- excludes another kind of acne, acne keloid, which is separately reportable with L73.0 (Acne keloid). Know Your Provider’s Treatment Options Most practitioners will choose conservative methods when starting acne treatment, like medications such as benzoyl peroxide, topical retinoids, and antibiotics. Services rendered to the patient that result in prescribing any medication can be reimbursed by billing an evaluation and management (E/M) code from 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) based on the history, exam, and medical decision making documented by the provider during the visit. If a practitioner decides to treat the acne in the office, the most common procedures you will see in a physician setting will be 10040 (Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)), 10060 (Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single), or 10061 (… complicated or multiple) for the incision and drainage of abscesses. You may also see 17360 (Chemical exfoliation for acne (eg, acne paste, acid), 17340 (Cryotherapy (CO2 slush, liquid N2) for acne), or 15780 (Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis)), though these are less common in pediatric settings. Familiarize Yourself With Payer Policies The provider's compensation for these procedures will depend on the payment guidelines of the insurance companies being billed. When it comes to billing for things like acne, some common challenges may involve the procedure being deemed experimental, cosmetic, or not medically necessary. For instance, UnitedHealthcare does not cover 15780, viewing the procedure as cosmetic, whereas Aetna deems CPT® code 10040 medically necessary when L70.0 is the diagnosis. Therefore, securing preapproval from the insurer and/or acquiring financial consent from the patient prior to the procedure will ensure clear communication between the service provider and the patient. Scenario 2 A 16-year-old patient visits their pediatrician, complaining of persistent skin issues. They describe symptoms such as redness on the cheeks, nose, and forehead, along with small, pus-filled bumps. The teenager also mentions that these symptoms seem to worsen with exposure to sun and heat, and that they have been experiencing this for the past few months. Despite their similar appearances, acne and rosacea are distinct conditions. This is why the term “acne rosacea” can lead to confusion. While this condition does exist, there isn’t a specific ICD-10-CM code for it. More commonly, acne rosacea is referred to as papulopustular rosacea, a form of rosacea marked by pustules that mimic acne. When you look up “acne” in the ICD-10-CM Alphabetic Index, you’ll see instructions to code the condition with L71.9 (Rosacea, unspecified). However, when you look up “rosacea” in the index, it also lists L71.9, but directs you to L71.8 (other rosacea) for types of rosacea that are specified but not elsewhere classified (NEC). This type of rosacea was specified, there just isn’t a code for it, so L71.8 is the best choice. Be aware: While acne and rosacea may look similar to one another, they are different conditions that have separate, distinct diagnoses. Your provider might use the term “acne rosacea” to describe a certain condition. However, it’s important to note that this is not acne, but rather a type of rosacea. This is more frequently referred to as “papulopustular rosacea.” Fortunately, you can easily code this by using L71.9 (Rosacea, unspecified) for the condition. Again, you will choose an E/M code from 99202-99215 based on the history, exam, and medical decision making documented by the provider during the visit. Lindsey Bush, BA, MA, CPC, Production Editor, AAPC
