星空入口

Hint: Sometimes the rash is the first sign, sometimes one of the last.

According to the American Academy of Pediatrics, skin complaints are common. Roughly 10 to 20 percent of visits by children to outpatient facilities are associated with a dermatological problem as the primary reason for the visit, a secondary concern, or an incidental finding.

Recognizing the characteristics of a rash and describing them accurately are keys to accurate diagnosis reporting. Rashes are difficult to differentiate by appearance alone; it is important to consider the entire clinical presentation to help make the appropriate definitive diagnosis. The unique patterns of lesion distribution, such as the arrangement of lesions, may also provide a clue to the diagnosis. Obtaining an appropriate history and exam is the first step.

Last month, we looked at general rashes that pediatric patients may exhibit. Read on for more information on viral, bacterial, and fungal rashes.

Explore These Common Viral Rashes

Roseola infantum, sometimes referred to as sixth disease, is caused by human herpesvirus 6. The rash is pinkish-red, usually begins on the trunk, and then spreads to the extremities or even the face. Separate raised lesions or flat spots that do not itch occur but there is no pain associated. This condition develops sometimes after a sudden high fever and lasts for a few days. You can find the appropriate ICD-10-CM code in the B08- (Other viral infections characterized by skin and mucous membrane lesions, not elsewhere classified) code category, including B08.20 (Exanthema subitum [sixth disease], unspecified).

Measles, also known as rubeola, is a respiratory virus that also manifests as a rash. Measles present as a red, blotchy rash on the face and behind the ears, then spreads down to the chest and back, finally reaching the feet. The rash lasts four to seven days, and can first appear as tiny spots that later join to make large patchy bumps that are not itchy. The infection and incubation period typically starts 10 to 14 days after exposure and there are no signs or symptoms during this time. For these diagnoses, look to the B05- (Measles) code family.

Chickenpox is caused by the varicella zoster virus. This virus brings on an itchy rash with small, fluid-filled blisters. This is very contagious to those who have not had the disease or have not received a chickenpox vaccine. This virus is transmitted through airborne exposure. It can be dangerous or life-threatening. For these diagnoses, look to codes in the B01- (Varicella chickenpox) family.

Hand, foot, and mouth disease is typically caused by coxsackievirus A, a contagious virus that causes a very distinctive rash on the palms of the hands and soles of the feet. This can also appear in the diaper area, on the legs and arms, and around the mouth. The patient might also have small flat spots that can turn into blisters. For these patients, look to B34.1 (Enterovirus infection, unspecified).

Fifth disease, also known as erythema infectiosum, is a flat or raised rash that appears like a 鈥渟lapped cheek.鈥� This presents usually on the cheeks after onset of flu-like symptoms. In some cases, a secondary rash will develop on the arms, legs, trunk, and buttocks after the cheek rash and can last anywhere from two to 39 days. It may itch, and the rash goes from the center of the red areas toward the edges and has a lacy appearance. Once the rash appears the flu-like symptoms have disappeared. This can be documented with ICD-10-CM code B08.3 (Erythema infectiosum [fifth disease]).

Rubella is also known as German measles. The rash usually starts on the face and moves down the rest of the body. In pediatric patients, this rash is often the first symptom. It is highly contagious from person to person. This virus is different than the measles virus. When diagnosing these patients, look to the B06- (Rubella [German measles]) code family.

Molluscum contagiosum presents as small, raised sores on the body. These sores are usually small, flesh-colored pink bumps with a shiny appearance and slightly depressed center. They can be found on the face, eyelids, trunk, extremities, and genitalia, but typically do not appear on the palms or soles of the feet. The rash occurs mostly in children ages 1 to 10. It is highly contagious through direct contact. For these patients, look to B08.1 (Molluscum contagiosum).

Treating this, once diagnosed, is important to prevent the spreading of the virus. The virus can be treated with at-home topical remedies such as a retinoid prescribed by a physician. There may be times when additional treatments are recommended by the provider, such as in-office chemical treatments.

Beware of These Bacterial infections

Scarlet fever starts as a bright red rash on the face or neck, which then spreads to the chest, trunk, arms, and legs. It has the feel of sandpaper and can present with a sore throat and high fever. You can find scarlet fever diagnosis codes in the A38- (Scarlet fever) code family.

Impetigo can present in many ways, including reddish sores that burst and form a honey-colored crust, typically around the nose and mouth. It can also present as larger blisters, bullous impetigo, or even progress to ecthyma with painful sores that may leave scars. This type of rash is highly contagious. Impetigo diagnosis codes can be found in L01- (Impetigo) family.

Don鈥檛 Forget Fungal Origin

Candidal diaper rash is bright red or purple raised patches of skin often with bumps or tiny fluid-filled pimples, and is worse in skin folds. The correct coding for this is B37.2 (Candidiasis of skin and nail) as the primary diagnosis, and L22 (Diaper dermatitis) as the secondary diagnosis.

Tinea, also known as ringworm, is a red, itchy, ring-shaped, scaly rash on the arms and legs that then spreads to other large body areas. This rash spreads quickly to other body areas and is contagious. It can be transmitted through close contact. Tinea has many additional forms based on the location and rash presentation. You can report this diagnosis with codes in the B35- (Dermatophytosis) code family.

Testing is not always initiated during an initial visit. Your provider may order lab testing that would consist of scraping, or blood work to aid in accurate diagnosis, especially if the rash does not resolve after initial treatment.

One type of test for fungus can be reported with CPT^庐 code 87220 (Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)).

Rashes Can Lead to These In-Office Procedures

Ultraviolet phototherapy can be a safe and effective treatment for various skin conditions. The modality would be chosen by the provider after a full review of the severity and morphology of the skin condition.

Cantharidin (beetle juice) is an in-office, chemical destruction. This method causes a blister to form and lift off the skin. After a few days, when the blister has dried, the lesion will come off without leaving any scar.

Liquid nitrogen is used directly on bumps to freeze them. The provider may limit the use of this method in young children with many bumps, as this procedure is somewhat painful.

Curettage is directly scraping lesions to remove them. This method is not typically used with younger children with many bumps but can be effective for older kids and teenagers.

Sharonn Johnson, CPC, Senior Manager, CCR Services
at Pinnacle Enterprise Risk Consulting Services