259 Our recent “Transitioning to 10” articles have focused on elements of documentation that support assignment of specific International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. This article will focus on elements of documentation to support coding of dermatitis. In ICD-10-CM, categories L20–L30 and the terms dermatitis and eczema are used synonymously and interchangeably. However, in conditions such as dermatitis of the eyelid, the term eczematous or eczematoid is used as a descriptor to differentiate atopic from allergic contact dermatitis. Coding Tip High on the list of commonly reported diagnoses in pediatric ambulatory care is the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for unspecified contact dermatitis, 692.9. ICD-10-CM code L23.9, allergic contact dermatitis with unspecified cause, is generally equivalent to 629.9. However, as noted in the August 2013 AAP Pediatric Coding Newsletter™, more specific codes should be reported when the cause of dermatitis is known. Codes for contact dermatitis may specify allergic contact or irritant contact dermatitis (when diagnosed) in addition to identifying the causative agent. For example, code L23.7 specifies allergic contact dermatitis due to nonfood plants, making this the appropriate code for reporting dermatitis due to poison ivy, oak, or sumac. The differentiation between allergic and irritant contact dermatitis and identification of the causative substance are often based on history and presentation. When contact dermatitis is not distinguished as allergic or contact during an encounter, codes in category L25 are used to report unspecified contact dermatitis. When the causative agent is undetermined, it is appropriate to report code a code for contact dermatitis with unspecified cause (L23.9, L24.9, or L25.9). Coding Tip Codes for dermatitis of certain areas are specific to the site of the dermatitis. This includes diaper dermatitis, dermatitis of the eyelid, and dermatitis of the external ear. To arrive at a specific code for contact dermatitis using ICD-10-CM, the documentation elements shown in Table 1 are necessary. Documentation elements include the type of dermatitis and location or specified cause (when known). Incorporation of these terms in documentation will allow for more specific diagnosis assignment and may better support the necessity of services provided. Appendix B-16 Documenting Dermatitis (continued on page 260)
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