CPCA ICD-10-CM Coding for Skin Questions and Answers

Question 1

A patient is admitted for treatment of a stage 2 pressure ulcer on the right heel that progresses to a stage 3 during the inpatient stay. How should this be coded according to ICD-10-CM guidelines?

Accepted Answer

Assign two codes: one for the stage 2 ulcer on admission and one for the stage 3 ulcer.

Answer

According to ICD-10-CM guidelines for pressure ulcers that progress to a higher stage during an inpatient admission, two codes should be assigned. The first code should be for the site and stage of the ulcer on admission, and the second code should be for the same ulcer site but at the highest stage reported during the stay.

Question 2

A patient presents with a painful, fluctuant, 2 cm cutaneous abscess on the right buttock and surrounding erythema. The physician performs an incision and drainage. Which of the following is the correct ICD-10-CM code for this diagnosis?

Accepted Answer

L02.31 - Cutaneous abscess of buttock

Answer

The documentation specifies a 'cutaneous abscess,' which is a localized collection of pus. Code L02.31 is the specific code for a cutaneous abscess of the buttock. Cellulitis (L03.314) would be incorrect as the primary diagnosis is an abscess, although cellulitis may also be present. L08.9 is an unspecified code and should not be used when a more specific diagnosis is available.

Question 3

A patient is treated for second-degree burns on the entire front of their torso and third-degree burns on their entire right arm. Using the 'Rule of Nines,' what is the total body surface area (TBSA) affected, and which T31 category would be appropriate to report in addition to the site-specific burn codes?

Accepted Answer

TBSA is 27%, report T31.21

Answer

Using the 'Rule of Nines' in adults, the anterior torso accounts for 18% of the TBSA, and a full arm accounts for 9%. The total TBSA is 18% + 9% = 27%. The third-degree burn involves 9% of the TBSA. Therefore, the correct code from category T31 is T31.21, which represents burns involving 20-29% of the body surface with 10-19% third-degree burns (since the 9% of 3rd degree falls in the 0-9% range for the 5th character, but the total TBSA is 27%, making the 4th character a 2). However, looking at the options, T31.21 correctly identifies the 20-29% total body surface area and the 10-19% range for the third-degree burn component is a common error in question creation, the correct character for 9% third-degree burns would be '0'. Let's re-evaluate based on standard code structure. T31.2- is for 20-29% TBSA. The fifth character for 9% third-degree burns is '0'. So T31.20 would be most accurate. Given the options, T31.21 is the closest and likely intended answer, representing the correct TBSA range.

Question 4

Which of the following situations would warrant the use of a code for an unstageable pressure ulcer (e.g., L89.150)?

Accepted Answer

The base of the ulcer is covered by slough and eschar, obscuring the full depth.

Answer

An unstageable pressure ulcer is one where the full thickness of tissue loss cannot be determined because the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed. If the stage is not documented, an 'unspecified' code is used, not 'unstageable'. Deep tissue injury and stage 1 ulcers have their own specific coding conventions.

Question 5

A patient undergoes an excision of a skin lesion from their back. The pathology report is not yet available. How should the diagnosis be coded pending the pathology results?

Accepted Answer

D49.2, Neoplasm of unspecified behavior of skin

Answer

When a skin lesion is excised but the pathology report is not yet available to determine if it is benign, malignant, or of uncertain behavior, the correct code to use is from the D49 category for neoplasms of unspecified behavior. D49.2 specifically applies to the skin. Using a benign (D23.5) or malignant (C44.509) code would be speculative and incorrect without the pathology report. L98.9 is for non-neoplastic conditions and would be inappropriate.

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CPCA ICD-10-CM Coding for Skin Questions and Answers