ICD-10 Documentation Tips for Pulmonary ICD-10

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ICD-10 Documentation Tips for Pulmonary ICD-10

ICD-10 DOCUMENTATION TIPS FOR DERMATOLOGY DIAGNOSISICD-10DOCUMENTATION Documentation REQUIREMENTS Tips for Pulmonary Abscess, 1) Document anatomic site(s) 2) Document infecting organism if known Carbuncle and Furuncle Acne 1) When known, further specify acne as: -Conglobata -Excoriee des jeunes filles -Infantile -Tropica -Varioliformis -Vulgaris Cellulitis and 1) Document both conditions if 2) Document infecting organism if present known Acute Lymphangitis Dermatitis and 1) Specify if contact dermatitis is due 3) If outbreak due to medication, to an: specify if medication: Eczema -Allergen or -Came in contact with skin or -Irritant -Was taken internally 2) Document cause or trigger such as: -Cosmetics -Detergent Laterality 1) Document when appropriate: -Right -Left or -Bilateral Neoplasms 1) Document specific site, for 2) Differentiate between primary 3) For secondary sites: example: and secondary (metastatic) site -Document primary site and if it is still -Basal cell carcinoma of skin of left, present upper arm -Melanocytic nevi of right, upper eyelid Non-pressure 1) Document site(s) of non-pressure 2) Document the degree of tissue 3) Document etiology of ulcer such skin ulcer, for example: breakdown: as: Skin Ulcers -Right calf -Skin breakdown -Diabetic skin ulcer -Left heel -Fat layer exposed -Venous stasis ulcer -Muscle necrosis -Bone necrosis Pemphigoid 1) When known, further specify pemphigoid as: -Bullous -Cicatricial -Chronic bullous disease of childhood -Acquired epidermolysis bullosa -Epidermolysis bullosa d/t drug Pressure Ulcers 1) Site and stage of pressure ulcer 2) Physician must document 4) Stage of pressure ulcer can be needed for coding diagnosis of pressure ulcer taken from nursing notes 3) Document specific site(s) such as: -Right buttock -Left upper back Psoriasis and 1) When known, further specify type 2) When known, further specify 3) For psoriatic arthritis, further of psoriasis as: type of parapsoriasis as: specific as: Parapsoriasis -Acrodermatitis continua -Pityriasis lichenoides et varioliformis -Distal interphalangeal -Generalized pustular acuta or chronica -Juvenile arthropathy -Guttate -Retiform -Mutilans -Palmaris et plantaris -Small plaque or large plaque -Spondylititis -Vulgaris ICD-10 DOCUMENTATION TIPS FOR DERMATOLOGY Sarcoidosis, 1) Link disease and target organ ICD-10involvement Documentation such as: Tips for Pulmonary Scleroderma and -Sarcoidosis of skin SLE Drug 1) Document: - 2) Document reason for -Intentional underdosing, for example: Underdosing versus -Financial hardship -Unintentional or -Age related dementia .

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Pityriasis Rosea DANIEL L
CARING FOR COMMON SKIN CONDITIONS Pityriasis Rosea DANIEL L. STULBERG, M.D., Utah Valley Regional Medical Center, Provo, Utah JEFF WOLFREY, M.D., Good Samaritan Regional Medical Center, Phoenix, Arizona Pityriasis rosea is a common, acute exanthem of uncertain etiology. Viral and bacterial causes have been sought, but convincing answers have not yet been found. Pityriasis O A patient informa- rosea typically affects children and young adults. It is characterized by an initial herald tion handout on pityriasis rosea, written patch, followed by the development of a diffuse papulosquamous rash. The herald by the authors of this patch often is misdiagnosed as eczema. Pityriasis rosea is difficult to identify until the article, is provided on appearance of characteristic smaller secondary lesions that follow Langer’s lines (cleav- page 94. age lines). Several medications can cause a rash similar to pityriasis rosea, and several diseases, including secondary syphilis, are included in the differential diagnosis. One small controlled trial reported faster clearing of the exanthem with the use of ery- thromycin, but the mechanism of effect is unknown. Resolution of the rash may be has- tened by ultraviolet light therapy but not without the risk of hyperpigmentation. Top- ical or systemic steroids and antihistamines often are used to relieve itching. (Am Fam Physician 2004;69:87-92,94. Copyright© 2004 American Academy of Family Physicians.) This article is one in a ityriasis rosea is a common skin cytes, a decrease in T lymphocytes, and an ele- series coordinated by condition characterized by a her- vated sedimentation rate.6 Daniel L. Stulberg, M.D., director of der- ald patch and the later appear- Unfortunately, even though electron matology curriculum at ance of lesions arrayed along microscopy shows some viral changes and the Utah Valley Family Langer’s lines (cleavage lines).
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History of Psoriasis and Parapsoriasis
History of Psoriasis and Parapsoriasis By Karl Holubar Summary Parapsoriasis is «oï a disease entity. Jt is an auxiliary term introduced in J 902 to group several dermatoses w>itk a/aint similarity to psoriasis. Tlie liistorical development leading to tlie creation o/ t/ie term parapsoriasis is outlined and t/te Itistory o/psoriasis is 6rie/ly reviewed. Semantic and terminological considerations Obviously, para-psoriasis as a term has been created in analogy to psoriasis. We should remember similar neologisms in medical language, e. g. protein and para-protein; typhoid and para-typhoid, thyroid and para-thyroid, phimosis and para-phimosis, eventually, pemphigus and para-pemphigus (the latter in 1955 this term was to be employed instead of pemphigoid but was not accepted by the dermatological world). Literally, para is a Greek preposition, (with the genitive, dative and accusative), meaning: by the side of, next to something, alongside something. In medicine, para is used often as a prefix to another term, which designates a condition somewhat similar to the one under consideration. The same holds for psoriasis and parapsoria- sis. In detail, though, it is a bit more complicated. Parapsoriasis has more than one "/at/ier", three in fact: ideiurick /Iu.spitz f 1835—1886,), Paul Gerson Luna (A850—1929j and Louis Procç fI856—I928J. Auspitz, in 1881, had published a new system of skin diseases the seventh class of which was called epidermidoses, subdivided into liypcrlcfiratose.s, parakeratoses, kerato/y- ses, the characteristics of which were excessive keratinization, abnormal keratinization and insufficent keratinization. When Unna, in 1890®, pub- lished his two reports on what he called parakeratosis variegata, he referred to Auspitz' system and term when coining his own.
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Errata to the 7/1/2016 Prioritized List
Errata to the 7/1/2016 Prioritized List 1) On 6/29/2017, the following corrections were made: a. Website addresses were corrected for the new Oregon Health Authority Web site in all guideline notes referencing a Coverage Guidance. In addition, a web address in the Multisector Interventions section on Tobacco Use was updated. b. M67.0 (Short Achilles tendon (acquired)) was moved to line 297 NEUROLOGICAL DYSFUNCTION IN POSTURE AND MOVEMENT CAUSED BY CHRONIC CONDITIONS from line 382 DYSFUNCTION RESULTING IN LOSS OF ABILITY TO MAXIMIZE LEVEL OF INDEPENDENCE IN SELF- DIRECTED CARE CAUSED BY CHRONIC CONDITIONS THAT CAUSE NEUROLOGICAL DYSFUNCTION c. Psoriasis corrections: i. Add psoriasis, parapsoriasis and similar ICD-10 codes to line 544 MILD PSORIASIS; DERMATOPHYTOSIS: SCALP, HAND, BODY, DEEP-SEATED 1. L40.0 Psoriasis vulgaris 2. L40.1 Generalized pustular psoriasis 3. L40.2 Acrodermatitis continua 4. L40.3 Pustulosis palmaris et plantaris 5. L40.4 Guttate psoriasis 6. L40.8 Other psoriasis 7. L40.9 Psoriasis, unspecified 8. L41.0 Pityriasis lichenoides et varioliformis acuta ii. Add psoriatic arthropathy ICD-10 codes to line 50 RHEUMATOID ARTHRITIS AND OTHER INFLAMMATORY POLYARTHROPATHIES) and remove from line SEVERE INFLAMMATORY SKIN DISEASE 1. L40.51 Distal interphalangeal psoriatic arthropathy 2. L40.52 Psoriatic arthritis mutilans 3. L40.53 Psoriatic spondylitis 4. L40.54 Psoriatic juvenile arthropathy 5. L40.59 Other psoriatic arthropathy d. Add line 544 to Guideline Note 21 SEVERE INFLAMMATORY SKIN DISEASE, and append “See Guideline Note 57 for the definition of mild psoriasis included on line 544.” e. Add line 430 to Guideline Note 57 MILD PSORIASIS and append “See Guideline Note 21 for the definition of moderate/severe psoriasis included on line 430.” f.
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The Prevalence of Paediatric Skin Conditions at a Dermatology Clinic
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A Deep Learning System for Differential Diagnosis of Skin Diseases
A deep learning system for differential diagnosis of skin diseases 1 1 1 1 1 1,2 † Yuan Liu , Ayush Jain , Clara Eng , David H. Way , Kang Lee , Peggy Bui , Kimberly Kanada , ‡ 1 1 1 Guilherme de Oliveira Marinho , Jessica Gallegos , Sara Gabriele , Vishakha Gupta , Nalini 1,3,§ 1 4 1 1 Singh , Vivek Natarajan , Rainer Hofmann-Wellenhof , Greg S. Corrado , Lily H. Peng , Dale 1 1 † 1, 1, 1, R. Webster , Dennis Ai , Susan Huang , Yun Liu * , R. Carter Dunn * *, David Coz * * Affiliations: 1 G oogle Health, Palo Alto, CA, USA 2 U niversity of California, San Francisco, CA, USA 3 M assachusetts Institute of Technology, Cambridge, MA, USA 4 M edical University of Graz, Graz, Austria † W ork done at Google Health via Advanced Clinical. ‡ W ork done at Google Health via Adecco Staffing. § W ork done at Google Health. *Corresponding author: [email protected] **These authors contributed equally to this work. Abstract Skin and subcutaneous conditions affect an estimated 1.9 billion people at any given time and remain the fourth leading cause of non-fatal disease burden worldwide. Access to dermatology care is limited due to a shortage of dermatologists, causing long wait times and leading patients to seek dermatologic care from general practitioners. However, the diagnostic accuracy of general practitioners has been reported to be only 0.24-0.70 (compared to 0.77-0.96 for dermatologists), resulting in over- and under-referrals, delays in care, and errors in diagnosis and treatment. In this paper, we developed a deep learning system (DLS) to provide a differential diagnosis of skin conditions for clinical cases (skin photographs and associated medical histories).
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PWO for Home Phototherapy
Physician’s Written Order For Office Use Only : Daavlin PO Box 626 Bryan, OH 43506 For Home Phototherapy Fax To: 419-636-7916 Other__________________________ Rx Prescriber Instructions: This form is a Prescription and Statement of Medical Necessity for Billing Entity ___________________________________ Daavlin home phototherapy products. (For Levia orders, please use the Levia version of ___________________________________ this form.) All fields are required for insurance approval. Call 800-322-8546 for assistance. First Name _______________________ Last Name _________________________ Middle Initial ____ DOB ____/____/____ Address _________________________________________ City_________________________ State_______ Zip___________ Patient: Gender: M F Phone #________________________________ Alt Phone #_________________________________ Physician Name _________________________________ ICD-10 : Description ICD-10 Code L40 . _____ Psoriasis Must Be Practice ________________________________________ Indicated L80 Vitiligo NPI# ____________________________________________ ______ . ____ Other: ____________________ (See back for ICD -10 Code Quick Referrence Guide) Address _______________________________________ Estimated Duration of Need: ___ Months ( 99 = Lifetime ) City ____________________ State ____ Zip _________ Body Area Affected (Check all that apply) Prescribing Physician: Prescribing Phone (____)_____________*Fax (____)_____________ 3 % - 10 % (Moderate) Hands (2 %) * IMPORTANT: We will use this fax number to fax the Prescriber’s Dosing
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Pediatric Psoriasis
Pediatric Papulosquamous and Eczematous Disorders St. John’s Episcopal Hospital Program Director- Dr. Suzanne Sirota-Rozenberg Dr. Brett Dolgin, DO Dr. Asma Ahmed, DO Dr. Anna Slobodskya, DO Dr. Stephanie Lasky, DO Dr. Louis Siegel, DO Dr. Evelyn Gordon, DO Dr. Vanita Chand, DO Pediatric Psoriasis Epidemiology • Psoriasis can first appear at any age, from infancy to the eighth decade of life • The prevalence of psoriasis in children ages 0 to 18 years old is 1% with an incidence of 40.8 per 100,000 ppl • ~ 75% have onset before 40 years of age What causes psoriasis? • Multifactorial • Genetics – HLA associations (Cw6, B13, B17, B57, B27, DR7) • Abnormal T cell activation – Th1, Th17 with increased cytokines IL 1, 2, 12, 17, 23, IFN-gamma, TNF-alpha • External triggers: – Injury (Koebner phenomenon) – medications (lithium, IFNs, β-blockers, antimalarials, rapid taper of systemic corticosteroids) – infections (particularly streptococcal tonsillitis). Pediatric Psoriasis Types: • Acute Guttate Psoriasis – Small erythematous plaques occurring after infection (MOST common in children) • 40% of patients with guttate psoriasis will progress to develop plaque type psoriasis • Chronic plaque Psoriasis – erythematous plaques with scaling • Flexural Psoriasis – Erythematous areas between skin folds • Scalp Psoriasis – Thick scale found on scalp • Nail Psoriasis – Nail dystrophy • Erythrodermic Psoriasis– Severe erythema covering all or most of the body • Pustular Psoriasis – Acutely arising pustules • Photosensitive Psoriasis – Seen in areas of sun
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The Conundrum of Parapsoriasis Versus Patch Stage of Mycosis Fungoides
View TThehe cconundrumonundrum ofof parapsoriasisparapsoriasis versusversus patchpatch stagestage Point ooff mmycosisycosis ffungoidesungoides KK.. NN.. SSarveswari,arveswari, PPatrickatrick YYesudianesudian Sundaram Medical Foundation, ABSTRACT Dr. Rangarajan Memorial Hospital, Chennai, Tamilnadu, Terminological confusion with benign dermatosis, such as parapsoriasis en plaques, makes India it difÞ cult to diagnose mycosis fungoides in the early patch stage. Early diagnosis of mycosis fungoides (MF) is important for deciding on type of therapy, prognosis and for further follow-up. Address for correspondence: Dr. K. N. Sarveswari, However, until recently, there has been no consensus on criteria that would help in diagnosing Sundaram Medical the disease early. Some believe that large plaque parapsoriasis (LPP) should be classiÞ ed Foundation, Dr. Rangarajan with early patch stage of MF and should be treated aggressively. However, there is no Þ rm Memorial Hospital, Shanthi clinical or laboratory criteria to predict which LPP will progress to MF and we can only discuss Colony - IV Avenue, Anna about statistical probability. Moreover, long-term outcome analysis of even patch stage of MF Nagar, Chennai - 600 040, Tamilnadu, India. is similar to that of control population. We therefore believe that LPP should be considered E-mail: sarveswari@ as a separate entity at least to prevent the patient from being given a frightening diagnosis. smfhospital.org We also feel that patients need not be treated with aggressive therapy for LPP and will need
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Pityriasis Lichenoides Devang G
pediatric dermatology Pityriasis Lichenoides Devang G. Patel, MD George Kihiczak, MD Robert A. Schwartz, MD, MPH Camila K. Janniger, MD W. Clark Lambert, MD, PhD Pityriasis lichenoides (PL) is a skin disorder of un- PL from small and large plaque parapsoriasis, includ- known etiology that mainly affects children and young ing digitate dermatosis, xanthoerythrodermia perstans, adults. Pityriasis lichenoides is perhaps best considered and the rare entity, retiform parapsoriasis. a disease spectrum with acute and chronic types: pityr- iasis lichenoides et varioliformis acuta (PLEVA) and Incidence pityriasis lichenoides chronica (PLC). Pityriasis Pityriasis lichenoides most commonly occurs in chil- lichenoides et varioliformis acuta, the acute variant, is dren and young adults; however, its precise incidence characterized by the onset of papulovesicular eruptions is unknown. Both PLC and PLEVA appear to be that evolve into necrotic lesions over the trunk and about as common in males as in females, with PLC extremities, and hence the name “varioliformis,” occurring more frequently. Pityriasis lichenoides et which means “like variola” (like smallpox). Pityriasis varioliformis acuta most often occurs during the sec- lichenoides chronica, the chronic form, involves re- ond or third decade of life. However, the disease may current crops of papules that may last from several also arise in children and the elderly, and may even months to several years. Both types are further char- be evident at birth.10 There is no apparent racial or acterized by independent evolution of each lesion, so geographic predisposition.1,2 that lesions in all different states of progression are found next to each other in a random array.
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Pityriasis Lichenoides-Like Drug Reaction
Volume 23 Number 11 | November 2017 Dermatology Online Journal || Case Report 23 (11): 2 Pityriasis lichenoides-like drug reaction: A clinical histopathologic study of 10 cases Cynthia Magro1 MD, Ruifeng Guo2 MD PhD, Giang Huong Nguyen3 MD PhD, Hamilton Tsang4 MD, Shabnam Momtahen5 MD Affiliations: 1Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, 2University of Florida Health Pathology Laboratories, Gainesville, Florida, 3Department of Dermatology, University of Colorado, Aurora, Colorado, 4Department of Laboratory Medicine, University of Washington, Seattle, Washington, 5Department of Pathology, Dartmouth- Hitchcock Medical Center, Lebanon, New Hampshire Corresponding Author: Cynthia M. Magro M.D., Professor of Pathology and Laboratory Medicine, Professor of Dermatopathology in Dermatology, Director of Dermatopathology, Weill Cornell Medicine, Department of Pathology & Laboratory Medicine, 1300 York Avenue, F-309, New York, NY 10065, Tel: 212-746-6434, Fax: 212-746-8570, Email: [email protected] Abstract Introduction Cutaneous drug eruptions define a common Background: Lymphomatoid drug reactions can mimic adverse effect of drug therapy [1-5]. Although most endogenous T and B cell lymphoproliferative diseases. drug eruptions are mild, life-threatening reactions Objectives: We present a novel form of cutaneous are common. These include Stevens-Johnson drug reaction with features of pityriasis lichenoides syndrome, toxic epidermal necrolysis, erythroderma, (PL), a recognized form of T cell dyscrasia. Methods: and angioedema [6-9]. Most drug eruptions Ten cases were studied where a cutaneous eruption are immunologically mediated, although non- exhibiting semblance to PL within a few weeks to immunological drug eruptions are known to occur months after starting a particular drug. Results: The [10].
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Infantile Psoriasis
PEDIATRIC DERMATOLOGY Series Editor: Camila K. Janniger, MD Infantile Psoriasis Camila K. Janniger, MD; Robert A. Schwartz, MD, MPH; Maria Letizia Musumeci, MD, PhD; Aurora Tedeschi, MD; Barbara Mirona, MD; Giuseppe Micali, MD Psoriasis is a common inherited papulosqua- several chromosomes at which putative psoriasis mous dermatosis that may be a diagnostic genes may be located. Disease susceptibility genes dilemma, particularly in infants and children. The are thought to be present on chromosomes 4q, 6p, treatment of children with psoriasis should be 16q, and 20p. Moreover, on chromosome 1q, genes handled with caution and tailored according to regulating epidermal differentiation have been iden- the child’s age, as well as to the extent, distribu- tified. Linkage to this area has been proposed. tion, and type of psoriasis. Furthermore, psoriasis gene loci on chromosomes 2, Cutis. 2005;76:173-177. 8, and 20 have been suggested.12 Physical injury to the skin (Köbner phe- soriasis is a common inherited papulosquamous nomenon), low humidity,5 cold weather, and stress dermatosis that often represents a diagnostic may represent important triggering factors.9 Worsen- P dilemma in infants.1-3 The diagnosis may be ing of psoriasis following stress was observed in 50% challenging if the disease is mild or if the presenta- of 223 pediatric patients in one survey and in 90% tion is atypical.4 of 245 children in another.9,13 In addition, in young children, viral or bacterial infection (particularly Pathogenesis due to Streptococcus) may be a common initiating Both genetic and environmental factors interact to and maintaining factor, especially for the develop- precipitate the development of psoriasis.5 A family ment of acute guttate psoriasis.14,15 history of psoriasis is seen in 25% to 71% of patients In childhood, psoriasis may be induced by some with the disease.2,6-9 Generally, an earlier onset of medications, the most common being antimalarials the disease correlates with familial frequency7; the and systemic corticosteroids.
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A Dissertation on a CLINICAL STUDY of NAIL CHANGES in PAPULOSQUAMOUS DISORDER
A Dissertation on A CLINICAL STUDY OF NAIL CHANGES IN PAPULOSQUAMOUS DISORDER Dissertation Submitted to THE TAMILNADU Dr.M.G.R. MEDICAL UNIVERSITY CHENNAI - 600 032 With partial fulfillment of the regulations for the award of M.D. DEGREE IN DERMATOLOGY , VENEREOLOGY AND LEPROLOGY (BRANCH – XII) COIMBATORE MEDICAL COLLEGE, COIMBATORE MAY 2018 DECLARATION I Dr. A. AMUTHA solemnly declare that the dissertation entitled “A CLINICALSTUDY OF NAIL CHANGES IN PAPULOSQUAMOUS DISORDER ” is a bonafide work done by me at Coimbatore Medical College Hospital during the year JUNE 2016- JUNE 2017 under the guidance & supervision of Dr.M .REVATHY M.D.,D.D., Professor & Head of Department, Department of Dermatology, Coimbatore Medical College & Hospital. The dissertation is submitted to Dr.MGR Medical University toward partial fulfilment of requirement for the award of MD degree branch XII Dermatology, Venereology and Leprology. PLACE: Dr A. AMUTHA DATE : COPYRIGHT DECLARATION BY THE CANDIDATE I hereby declare that The Tamilnadu Dr. M.G.R Medical University, Chennai shall have the rights to preserve, use and disseminate thisdissertation / thesis in print or electronic format for academic / researchpurpose. PLACE: COIMBATORE Dr.A.AMUTHA DATE: CERTIFICATE This is to certify that the dissertation entitled “A CLINICAL STUDY OF NAIL CHANGES IN PAPULOSQUAMOUS DISORDER” is a bonafide original work done by Dr. A. AMUTHA post graduate student in the Department of Dermatology, Venereology and Leprology, Coimbatore Medical College Hospital during the year JUNE 2016- JUNE 2017 under the guidance & supervision of Dr.M.REVATHYM.D (Derm)., Professor & Head of Department, Department of Dermatology, Coimbatore Medical College & Hospital. The dissertation is submitted to Dr.MGR Medical University toward partial fulfilment of requirement for the award of MD degree branch XII Dermatology, Venereology and Leprology.
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