Chapter 7 - Integumentary System Flashcards
Main ICD chapters for integumentary system
- Neoplasms, 12 diseases of skin and subcutaneous tissues, 19 injury, poisoning and other external causes
Common bacterial skin infections
Impetigo, cutaneous abscess, carbuncles, furuncles, cellulitis, lymphangitis, lymphadenitis, and folliculitis
Common fungal skin infections
Athletes foot, jock itch, ringworm, yeast infection
Impetigo
Bacteria entering the skin, typically through cuts or insect bites. Typical in children and infants
Cutaneous abscess
Localized collection of pus in the skin. Caused by staphylococcal infection.
Carbuncle and furuncles
Boils. Follicle based cutaneous abscess. Several furuncles make up a carbuncle. Swollen lump filled with pus that can be painful. Typically heals on its own within a couple weeks.
Cellulitis
Bacterial infection of the skin. Skin appears warm, swollen, and red. Coded from L03
Lymphangitis
Infection of the lymph vessels. Sign that infection is getting worse. Codes from L03
Lymphadenitis
Infection of the lymph nodes. Codes from L04
Pilonidal Cyst
Cyst, fistula, or sinus under the skin located at the bottom of the tailbone. Can contain hair, skin debris, and other abnormal tissue. If it becomes infected considered an abscess. Coded from L05.
Inflammatory conditions of the skin
Dermatitis, erythema, rosacea, and psoriasis.
Dermatitis
Inflammation of the skin. Seborrheic, atopic, and contact.
Seborrheic dermatitis
Scaly, itchy, red skin. Typically found on the scalp. Called dandruff in adults. Cradle cap in infants.
Atopic dermatitis
Eczema. Itchy rash that comes and goes. Can be chronic. Diaper rash is a form of atopic dermatitis.
Contact dermatitis
Inflammation caused by an external irritant. Can be chemical, food, or plant.
Contact dermatitis code selection
Depends on irritant causing the inflammation. When it is a drug or other irritant code for the external cause code as well due to the adverse effect.
Rash code
R21. Only used when indicated as rash with no other description or qualifications.
Psoriasis
Appears as patches of red skin covered in silvery scales. Often very itchy and painful. Coded by type. Category L40
Erythema
Redness of the skin due to capillary dilation. Multiple types. Rosacea, erythema multiforme, erythema nodosum.
Rosacea
Form of erythema. Typically in adults. Appears as red pustules on the face.
Erythema multiforme codes
Code associated manifestations, adverse effect of drug induced, and additional code from L49- to indicate % of skin exfoliation.
Urticaria
Hives. Appears as red, raised, itchy wheals that very in shape and size. Can be caused an allergy to food or medication, external factors like heat or friction, or idiopathic.
Keratosis
Overgrowth of the horny layer of the skin.
Actinic keratosis
Overgrowth caused by exposure to the sun. Scaly, crusty lesions of the skin. Precancerous. Include code for type of UV exposure. L57
Seborrheic keratosis
Benign growth typically not forming into cancer. L82
Warts
Growths on the skin typically caused by human papilloma virus. Often benign. Coded from B07.9 if caused by HPV.
Ingrown toenail
Caused when the skin on the side of the nail is pressed against the side of the nail. Typically by ill fitting shoes. Pressure causes skin to be irritated, red, and painful. L60.0
Alopecia
Hair loss. Alopecia areata, telogen effluvium. L63
Alopecia areata
Autoimmune disease where immune system attacks hair follicles causing hair loss.
Telogen effluvium
Type of alopecia. Caused by metabolic, hormonal stress, or medications.
Corns and callosities
Body’s way of protecting the skin. Typically result of constant friction. L84
Ulcer
Lesion of the skin caused by superficial loss of skin tissue. Coded by type. Diabetic, amebic, pressure.
Pressure ulcer
Known as bedsore or decubitus ulcer. Loss of tissue due to pressure on the skin. Commonly over bony prominences. 4 stages, unstageable, and unspecified.
Keloid scar
Excessive growth of connective tissue during the healing process. Can be removed or may get smaller over time. L91.0
Fine needle aspiration
Procedure to sample fluid or tissue from a cyst or mass. Can be image guided if hard to find by palpating. Coded based on type of imaging used. Add on codes for multiple sites using same type of imaging. Modifier for different site using different imaging
Hematoma
Collection of bloody fluid or blood clots. Incision and drainage performed using a hemostat.
Debridement
Removing dead tissue, eschar, dirt, foreign material or debris to promote healing or control infection. Not to be coded for second or third degree burns.
Partial thickness
Damage does not penetrate below the dermis and may be limited to the epidermis only.
Full thickness
Tissue damage involving loss of epidermis and dermis and extending into subcutaneous tissue and possibly muscle or bone.
Avascular
Lack in blood supply, devitalized, necrotic, and non-viable. Specific types slough and eschar
Clean wound
Free of devitalized tissue, purulent drainage, foreign material or debris
Clean wound edges
Edges of the top layers of epidermis have rolled down to cover the lower edge of the epidermis, so epithelial cells cannot migrate from wound edges. Can be described as epibole. Sealed edge of mature epithelium.
Dehisced / dehiscence
To split apart or open along natural or suture lines
Epithelization
Regeneration of epidermis across a wound surface
Eschar
Black or brown necrotic, devitalized tissue. Tissue can be loose or firmly adherent, hard, soft, or saggy.
Granulation tissue
Pink/red moist tissue comprised of new blood vessels, connective tissue, fibroblasts, and inflammatory cells that fill up an open wound when it starts to heal. Deep pink or red with irregular, berry like surface.
Healing ridge
Palpation reveals induration (hardening) beneath the skin extending about 1cm on each side of the wound. Evident 5-9 days after wounding. Persists about 15 days. Sign of positive healing
Sinus tract
Course of tissue destruction. Occurs in any direction from the surface or edge of a wound. Results in dead space with potential for abscess formation. Also called tunneling.
Slough
Soft, moist, avascular tissue. May be white, yellow, tan or green. May be loose or firmly adherent.
Undermining
Areas of tissue destruction extends under intact skin along the peripheral of a wound. Commonly seen in shear injuries.
Lesions
Abnormal change in the tissues of an area of the body such as a sore, rash, wound, injury, or growth and is usually localized.
Shaving of epidermal or dermal lesion
Removal of a lesion without taking a full thickness excision. Reported by body area and size.
Excision of a lesion
Full thickness removal of a lesion. Based on benign or malignant.
Benign lesion
Not spreading to adjacent sites. Usually cause secondary problems to the pressure exerted on surrounding structures. Often regular in shape and covered in a fibrous capsule. Cicatricial, fibrous, inflammatory, congenital, and cystic lesions
Hidradenitis
Inflammation of the sweat glands causing profuse sweating. Based on location and type of repair.
Malignant lesion
Cancerous growth invading adjacent tissues and may metastasize to parts of the body. Basal cell carcinoma, squamous cell carcinoma, and melanoma lesions. Various forms of removal.
Electrodesiccation
Destroys tissue using a small instrument with a cautery needle connected to a monopolar electric source. As the needle touches the tissue it is burned away.
Electrofulguration
Destroys tissue using high frequency electric current. Electrical sparks generated destroy the tissue. After a layer is destroyed it is scraped away. Repeated until removed. Results in a wide border of normal tissue being removed along with the malignant lesion.
Elliptical excision
Removal in an ellipse two or three times the required width. Through the dermis with some subcutaneous tissue visible when excised.
Measurement of lesions
Metric system. Measured before anesthesia. Report in centimeters. Verify by code if cm or sq cm. If size is not available report the smallest lesion size for the code. Don’t use pathology report for size as it has shrunk unless it’s a last resort.
Nondystrophic nails
Essentially normal nails unaffected by abnormal development or changes in structure or appearance.
Debridement of nails
Performed mechanically by a provider. May be indicated for hypertrophic dystrophic nails, mycotic (fungal) infections or patient lack with peripheral vascular disease. Code for 5 or less or 6 plus nails.
Avulsion of the nail plate
Partial or complete removal of the name. Single nail with add ons for additional nails.
Simple wound repair
Superficial wounds that primarily involve epidermis, dermis, and subcutaneous tissue without deep sutures. If only adhesive strips are used to closed report only an E/M code
Intermediate wound repair
Repair of epidermis, dermis, subcutaneous tissue requires layered closure of one or more of the subcutaneous tissues or non-muscle fascia. Includes limited undermining. Can also be used for single layer wound requiring extensive cleaning of foreign material
Complex wound repair
Repair of wounds with at least one of the following: exposure of bone, cartilage, tendon, or named neurovascular structure; debridement of wound edges, extensive undermining, involvement of free margins of helical rim, vermilion border, nostril rim, or retention sutures. Necessary prep includes creation of limited defects, debridement of complicated lacerations or avulsions.
Wound repair reporting tips
Measured in cm. Group by type of repair and anatomical site. Add same site and type together. List complicated to least complicated and add modifier 59.
Advancement flap
Undermining or freeing up tissue surrounding a defect creates an advancement flap. Tissue is now free to move forward into the defect and be sutured to the other wound edge.
Allograft
Skin transplanted from one person to another who is not genetically identical
Autograft / autologous
Skin is harvested from another section of the patient’s own body
Composite graft
Skin graft of more than one type of tissue. Tissues are aligned and used to plug a defect.
Derma-fascia-fat grafts
Service performed to smooth out blemishes created secondarily to surgically created defects or atrophy.
Double pedicle flap
Incision is made in the skin along the length of of the defect to be closed and the skin between the incision and the defect is freed leaving the ends of the flap attached. Flap moved over defect and sutured into place. Allows blood supply from both ends of the flap to be maintained.
Free fascia graft
Requires elevation and transfer of the fascia with micro vascular anastomosis. If subsequently covered with skin graft the skin graft is reported separately.
Full thickness graft
Graft composed of epidermis and dermis. Cut with scalpel and placed over defect and sutured into place.
Heterograft
Graft material transferred between species. Functions as a biological dressing.
Homograft
Graft from same species but not genetically identical. Lasts about 10 days. Promotes growth of new skin. Usually used to cover large burns.
Rotation flap
Incision made to create a curvilinear flap contiguous with the defect. When flap is dissected free it is rotated over the defect and sutured into place. Defect created by flap is sutured or grafted as needed.
Split thickness graft
Composed of epidermis and small portion of the dermis.
Pedicle flap
Base of the flap is eventually severed from blood supply. Often done in multiple stages and is formed in an area distant from the defect. Different than an adjacent tissue transfers.
Rhytid / rhytidectomy
Wrinkle. Wrinkle removal via face lift.
Electrosurgery
Tissue destruction method. Doesn’t require sutures and no concern for bleeding. Longer healing time.
Cryosurgery
Application of freezing temperatures to produce cell death and tissue destruction. Used for malignant lesions. Some form of liquid nitrogen is applied to the lesion.
Laser surgery
Using lasers to destroy tissues.
Tissue destruction coding
If multiple sites are destroyed more than one code is required. Not coded based on therapy type but by the tissue destruction procedure.
Mohs micrographic surgery
Unique procedure with surgeon acting as pathologist as well. Tissue is removed divided into tissue blocks and checked for positive margins. If positive another portion of the tumor is removed and tested. Each time the surgeon returns is a stage. If skin defect repair is needed it is coded separately. Coded by stages and tissue blocks.
Lumpectomy
Removal of a lesion of abnormal tissue from the breast. Is not a full mastectomy
Gynecomastia
Removal of excess fat and breast tissue in men due to abnormal enlargement of the breast.
Modified radical mastectomy
Removal of breast tissue but the pectoralis major is not removed.
Urban mastectomy
Similar to radical mastectomy but the internal mammary lymph nodes are removed as well
Photodynamic therapy
Ablation of tumorous tissues by activation of photoactive drugs. Involves use external light application. Reported once per day based on type of lesion being treated.
Actinotherapy
Exposure of skin to UV light to treat skin disease like acne.
Photochemotherapy
Combines light and chemicals to provide effective treatment. Gocekeman treatment is an example.
Goeckerman treatment
Application of tar or petrolatum and increasingly strong UV B light to treat psoriasis, eczema, or mycosis.
Melanoma
Tumor arising from the melanocystic system of the skin. Malignant.
