Taking a Closer Look at the June ICD-10 Coding Challenge

Blog by Julia Palmer

A patient presented to outpatient surgery for laser treatment of scars from third-degree burns. The patient had a large scar on her neck, one on her chest, and a third one on her abdomen. Laser treatment of the skin of each area was performed successfully.

The codes for last month’s scenario are as follows:
L90.5 Scar conditions and fibrosis of skin
T21.32XS Sequela of third degree burn of abdomen
T21.31XS Sequela of third degree burn of chest
T20.37XS Sequela of third degree burn of neck

OH57XZZ Destruction of skin of abdomen
OH55XZZ Destruction of skin of chest
OH54XZZ Destruction of skin of neck

A late effect, known as a sequela in ICD-10, is a residual effect or condition produced after an acute phase of a disease, illness, or injury has terminated. There is no time limit on when a late effect can occur. The residual condition may be apparent soon after the disease or condition has resolved, such as in a cerebral infarction, or it may occur months or years later, such as due to a previous injury. Generally, two codes are required when coding a sequela. The residual condition is sequenced first. In our scenario, the scars from the burns, L90.5, is the residual. The sequela code, which describes the injury that caused the residual condition, is sequenced second, and the 7th character of “S” clearly conveys that a sequela is present.

For the ICD-10-PCS procedure coding, the body system is Skin and Breast. The root operation is destruction which is defined as physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent. Laser treatment can help improve the appearance, texture, and thickness of burn scars. Three PCS codes are assigned consistent with the PCS coding guideline that states multiple procedure codes are assigned if the same root operation is performed on different body parts as defined by distinct values of the body part character. A separate body part character is provided for skin of abdomen, chest and neck.

Reference the full ICD-10-CM coding guidelines for sequelae in the ICD-10-CM Official Guidelines for Coding and Reporting, sections B.10 and I.C.1919. The guidelines can be downloaded here: http://www.cdc.gov/nchs/icd/icd10cm.htm
Reference the full ICD-10-PCS coding guidelines for assigning multiple procedure codes in the ICD-10-PCS Official Coding Guidelines, section B3.2. The guidelines can be downloaded here: http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html

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Julia Palmer is a Project Manager with the Consulting Services business of 3M Health Information Systems.

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