Integumentary System

burn v. corrosion

A burn is a thermal burn that comes from a heat source (except sunburns), such as a fire or hot appliance. Corrosion is a burn due to chemicals. *Burns and corrosions of external body surface (categories T20-T25) are classified by location, depth, extent and by agent (external cause code)

Nongranulating

Absence of granulation tissue, wound surface appears smooth as opposed to granular. For example, when a wound is clean but nongranulating, this indicates the wound surface appears smooth and red as opposed to berry-like.

Types of Skin Flaps

Advancement Flap—Undermining or freeing up tissue (from underlying fibrous attachments) surrounding a defect creates an advancement flap. This tissue is now free to move forward into the defect and be sutured to the other wound edge. This type of tissue transfer does not include any side or rotational movement of the tissues freed for advancement. Allograft—The skin graft is transplanted from one person to another who is not genetically identical; also called an allogenic skin graft Autograft/Autologous—Skin graft is harvested from another healthy part of the patient's own body. Composite Graft—This term refers to skin grafts including more than one type of tissue. The multiple tissues are aligned and used to plug a defect. This type of graft is usually done for both structural and cosmetic reasons. Derma-Fascia-Fat Grafts—This service is performed to smooth out blemishes created secondary to surgically created defects or atrophy. Double Pedicle Flap—An incision is made in the skin along the length of the defect to be closed and the tissue between the incision and the edge of the defect is freed, leaving the ends of the flap attached. The flap is moved into place over the defect and the edges are sutured. The double pedicle flap allows the blood supply to the tissue flap to be maintained from both ends of the flap Free Fascia Graft—This type of graft requires the elevation and transfer of fascia with microvascular anastomosis. If it is subsequently covered with a skin graft, the skin graft is reported separately. Full-thickness Graft—Graft is composed of epidermis and layers of the dermis. The graft is cut with a scalpel, placed over the defect, and sutured into place. Heterograft—This type of graft is synonymous with a xenograft, which is a graft material transferred between species (for example, a skin graft section made of pigskin that functions as a biological dressing). Homograft—The graft material originates from two individuals of the same species who are not genetically identical (for example, skin harvested from a cadaver and used as temporary cover). These grafts are commonly used only about 10 days, though they may last four to five weeks. They are usually used to cover large burns and stimulate the growth of new skin beneath them. Rotation Flap—A skin incision is made to create a curvilinear flap contiguous with the defect. When the flap is dissected free, it is pivoted into place over the defect and sutured into place. The defect created in making the flap is sutured or repaired with an additional graft, as necessary. Split-thickness Graft—The graft is composed of epidermis and a small portion of the dermis.

Undermining

Area of tissue destruction extends under the intact skin along the periphery of a wound; commonly seen in shear injuries. Involves a significant portion of the wound edge; whereas, sinus tract involves a small portion of wound edge.

Avulsion

Avulsion (tearing away) of a nail plate is described with 11730 for partial or complete; simple; single. procedure involves the physician removing part of or the entire fingernail or toenail. After local anesthetic is administered the physician separates the nail plate from the nail bed to remove the nail.

basil cell carcinoma

Basal cells are found in the epidermis. When basal cells become cancerous, it is considered basal cell carcinoma. Basal cell carcinoma is the most common type of skin cancer and when found early is highly curable.

Biopsy

Biopsy within the integumentary system specifically refers to biopsies of the skin, of sampling of a suspicious lesion. This can be performed by different techniques, such as a punch or incisional biopsy. Sutures often are needed to close the defect. Simple closure repair is included in the service and not reported separately. A tangential biopsy (shave, scoop, saucerize, curette) biopsy occurs when the provider uses a sharp instrument, such as a scalpel, and to remove/sample the suspicious lesion as close to the base of the lesion as possible to remove a sample of epidermal tissue with or without portions of underlying dermis.

The diagnosis codes for the skin are found primarily in what 4 chapters in ICD-10-CM?

Chapter 2: Neoplasms Chapter 12: Diseases of the Skin and Subcutaneous Tissue Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes Chapter 14: Diseases of the Genitourinary System. (Diagnoses for the breast are typically found in ICD-10-CM Chapter 14) We will cover them in this section because procedures performed on the breast are found in the Integumentary System section of the CPT® code book.

Clark's level of invasion

Clark's Level; which measures depth of penetration of the melanoma into the skin according to anatomic layer. · Level 1: Melanomas confined to the outermost layer of the skin, the epidermis. This is also called melanoma in-situ. · Level 2: Penetration by melanomas into the second layer of the skin, the dermis. · Level 3-4: Melanomas that invade deeper through the dermis but are still contained completely within the skin. · Level 5: Penetration of melanoma into the fat of the skin beneath the dermis, penetration into the sub cutis.

Medicine Codes for Debridement

Codes 97597-97602 describes active wound care management services to remove devitalized and/or necrotic tissue and to promote healing. Codes 97597 and 97598 report selective debridement based on total surface area of wound size. CPT® 97602 is a standalone code to report nonselective debridement of devitalized skin without the use of anesthesia. ***These codes are not reported in addition to 11042-11047.

Pairing and Cutting

Codes in this category are used for the removal of hyperkeratotic lesions, such as corns and calluses. The physician uses a sharp instrument either to pare or cut the corn or callus from the patient's body. Local anesthetic may be used. Code selection is based on how many lesions are removed.

Methods of debridement

Contaminated, infected, and dead skin tissues may be cut away from their attachments with scissors or a scalpel. Alternatively, the affected area may be debrided by flooding it with copious amounts of a physiological saline solution to wash away debris and other contaminants.

Sinus Tract

Course of tissue destruction. It occurs in any direction from the surface or edge of the wound; and, it results in dead space with potential for abscess formation. It's also called tunneling. Involves a small portion of the wound edge; whereas, undermining involves a significant portion of wound edge.

Adjacent tissue transfer involves a primary and secondary __________

Defect. Since both types of defects affect the amount of effort necessary to perform the procedure, the guidelines specify the need to include both the primary and secondary defects as part of the measurement for this type of repair

Closed Wound Edges

Epibole; edges of top layers of epidermis have rolled down to cover lower edge of epidermis, so epithelial cells cannot migrate from wound edges.

excision removal of a lesion

Excision is defined as full thickness removal of a lesion of the skin. The codes are selected first based on whether the lesion is benign or malignant

FNA

Fine needle aspiration; a fine-gauge needle and syringe is used to sample fluid or tissue from a cyst or mass. When the mass or cyst is difficult to find by palpation, imaging guidance such as ultrasound or fluoroscopic guidance is used. The FNA code is selected based on whether imaging guidance is used and the type of imaging guidance used. **Add-on codes are reported for each additional lesion that uses the same imaging guidance. When FNA is performed on a different lesion during the same encounter that uses a different type of imaging guidance, modifier 59 is reported.

Depth of burn/degree

First degree—involves the epidermis and can be superficial (such as sunburn). Second degree—involves the epidermis, dermis, and subcutaneous tissue and is partial thickness. Third degree—involves the epidermis, dermis, subcutaneous tissue, muscle, and sometimes bone.

introduction

In some cases, a patient presents with a lesion that does not require excision, yet the lesion needs treatment. The physician may choose to inject the lesion (such as warts, erythemas, hordeola, or keloid scars). The physician typically injects a steroid material into these lesions. Pay close attention to the number of injections because there are only two correct codes to use: 11900 is up to and including seven lesions; 11901 describes more than seven lesions injected.

Tissue expanders

In the case of the burn victim, the physician places a tissue expander under the skin and the patient returns to the office for expansion, which is done with injection of saline or air into the expander. The tissue expander allows the skin to be stretched so it can be harvested for transfer to a burn site or open wound site. For the breast cancer survivor, the tissue expander is placed during a more involved breast reconstruction surgery to be discussed later in this chapter.

biopsy of the nail unit.

In the documentation, it's important to identify the nail plate, bed, matrix, proximal, lateral or distal grooves, proximal or lateral fold, or the epithelium. The most common approach to a nail biopsy is a double punch, utilizing a punch tool similar to the tool used for a punch biopsy of the skin. A larger punch tool is used first, such as a 6 mm tool. To obtain the actual biopsy the physician will use a smaller punch tool, such as a 4 mm. The physician will determine if sutures are needed to close the biopsy site, or whether to let it heal by secondary intent.

what is the epidermis composed of?

It contains the pigment melanin, which gives skin its color and allows it to tan when exposed to sunlight. contains different types of cells — the most common are squamous cells (which are flat, scaly cells on the surface of the skin), basal cells (which are round cells), and melanocytes (which give the skin color). *does not contain blood vessels

is debridement included in global surgical package of treating a fracture/dislocation

No, because debridement and treatment of the fracture/dislocation are two separate and distinct procedures.

Healing Ridge

Palpatory finding is indicative of new collagen synthesis. Palpation (feeling or touching) reveals induration (hardening) beneath the skin extending to about one centimeter on each side of the wound. Becomes evident between five and nine days after wounding; typically persists until about 15 days after the wound occurs. This is an expected positive sign.

partial v full thickness

Partial thickness: refers to the epidermis and a portion of the dermis Full thickness: refers to the epidermis and the dermis

Epithelization

Regeneration of epidermis across a wound surface.

Slough

Soft, moist avascular (devitalized) tissue may be white, yellow, tan, or green; may be loose or firmly adherent.

implantable contraceptive devices

The insertion and removal of implantable contraceptive devices are also coded from this section. In looking at CPT® codes 11981-11983, it is important to pay close attention to how and what is being placed (for example, implantable capsule, subcutaneous hormone pellet or nonbiodegradable drug delivery implant).

Granulation Tissue

The pink/red, moist tissue comprised of new blood vessels, connective tissue, fibroblasts, and inflammatory cells, that fills an open wound when it starts to heal; it typically appears deep pink or red with an irregular, berry-like surface.

TBSA

Total body surface area affected by the burn. According to the ICD-10-CM Official Guidelines, a code from category T31 should be used to record burn mortality, such as in burn units, or when there is mention of a third degree burn involving 20 percent or more of the body surface (I.C.19.d.6.). ICD-10-CM categories T31 and T32 use the rule of nines to estimate the body surface area involved. Take note of the age of your patient as this can change the TBSA.

types of adjacent tissue transfers and rearrangements

V-Y advancement, Z, W, Limberg, or nasolabial transpositions and rotation flaps

wound healing by secondary intention.

When a primary defect is too large to bring together the wound edges, it can be left to heal from the bottom up via a process of laying down granulation tissue, which may require closure or reconstruction at a later date. This can take a much longer time to go through the process of epithelialization, scar formation, and contraction of wound edges.

Galactocele

a milk-fed cyst, often cured by aspiration.

lesions

an abnormal change in the tissues in an area of the body, such as a sore, rash, wound, injury, or growth, usually localized (confined to that area)

Skin tags

an outgrowth of both the epidermis and dermal fibrovascular tissue. most common area for skin tags is the neck, back, and folds of skin (such as the underarm). Skin tag removal often is performed by scissoring or any sharp method (using surgical scissors or a surgical blade to cut), ligature strangulation (tying suture material around the skin tag to stop the blood flow), electrosurgical destruction, or combination of treatment modalities, including chemical destruction or electrocauterization of wound, with or without local anesthesia. CPT® code selection is determined based on how many skin tags are removed.

wound

any physical injury involving a break in the skin, usually caused by an act or accident (for example, chest or puncture wound, gunshot wound). Wound repairs are divided into three categories: simple, intermediate, and complex.

Squamous cell carcinoma

arises in the squamous cells (the flat, scaly cells on the surface) and has a high cure rate when detected early.

Procedures involving the wrist are reported with the codes that include the _______ in the code descriptor.

arm

When multiple wounds require the same type of repair and are listed in the same anatomical region, add the lengths of each wound and report them _____________

as a single item (the sum of all the lengths).

Common fungal skin infections- ICD ch. 12

athlete's foot: A fungal infection that usually begins between the toes, commonly occurs in people whose feet have become very sweaty while confined within tight-fitting shoes. jock itch: Fungal infection in the skin of the genitals, inner thighs, and buttocks, most often occurs when people wear tight-fitting clothing that traps in moisture. causes an itchy, red, often ring-shaped rash in the groin area. ringworm: A highly contagious, fungal infection of the skin or scalp, is spread by skin-to-skin contact or by touching an infected animal or object. is typically scaly and may be red and itchy yeast infections: A yeast infection of the vagina and tissues at the opening of the vagina (vulva), this type of yeast infection is caused by the fungus candida and can cause inflammation, intense itchiness, and a thick, white discharge from the vagina.

types of malignant lesions

basal cell carcinoma, squamous cell carcinoma, and melanoma lesions

Pathology reports for malignant lesions will likely state

basal cell carcinoma, squamous cell carcinoma, carcinoma in-situ, melanoma, and melanoma in-situ

tissue transfer or rearrangement

best described as filling large defects by moving a flat piece of healthy tissue (preserving a connection on at least one side of its place of origin) into the defect

what is the dermis composed of?

blood vessels, connective tissue, nerves, lymph vessels, glands, receptors, and hair shafts. contains several important glands, such as the sebaceous glands, which secrete oil to keep the skin and hair soft and moist.

Hematoma

bruise, a collection of bloody fluid or blood clots incision and drainage of a hematoma is performed using a hemostat to remove blood clots.

types of benign lesions

cicatricial, fibrous, inflammatory, congenital, and cystic lesions.

Pathology reports for benign lesions will likely state

compound nevus, benign nevus, melanocytic nevus, epidermal nevus, congenital nevus, nevus sebaceous, and dysplastic nevus.

hidradenitis

condition causing inflammation of the sweat glands and is characteristic of profuse sweating. These codes are categorized based on the location of the hidradenitis and the type of repair. At the end of the category for benign lesion removal is a series of codes for reporting the excision of skin and subcutaneous tissue for hidradenitis (11450-11471).

Eschar tissue

dead tissue that sheds or falls off from the skin. It's commonly seen with pressure ulcer wounds (bedsores). Wounds are classified into stages based on how deep they are and how much skin tissue is affected. may be removed in debridement

secondary defect

defect created by the movement of tissue necessary to close the primary defect. In many instances, the secondary defect area must be considerably larger than the primary defect area, depending on factors such as location, skin mobility, and elasticity, or adjacent structures such as lip or eyelid Skin grafting is necessary to close secondary defects and is considered an additional procedure

When selecting the appropriate tissue transfer code, choose the code according to the size of the __________________

defect or wound to be covered. For example, when a lesion is removed, and an adjacent tissue transfer covers the remaining open wound/defect, code according to the size of the defect (in square centimeters), not by the size of the lesion. The excision of the lesion is included in the procedure.

Inflammatory conditions of the skin- ICD ch. 12

dermatitis: inflammation of the skin. there are different types of dermatitis such as: seborrheic dermatitis appears as scaly, itchy, red skin, and typically is found on the scalp. In adults, it often appears as dandruff, and in infants it is referred to as cradle cap. atopic dermatitis is also referred to as eczema. It is an itchy rash that comes and goes and can be chronic. Diaper rash is a form of atopic dermatitis contact dermatitis is inflammation caused by an external irritant. The irritant can be any type of chemical, food, or plant. *The code selection for contact dermatitis depends on the irritant causing the reaction. ** the appropriate external cause code is coded in addition to allergic or irritant contact dermatitis because it is due to an adverse effect of the drug or irritant. *Remember, if the rash is only identified as a rash, with no other description or qualification, it is coded as R21 Rash and other nonspecific skin eruption. psoriasis: appears as patches of red skin covered in silvery scales. It is often very itchy and can be painful. coded based on the type of psoriasis. L40. erythema: redness of the skin due to capillary dilation. rosacea is one of the most well-known type of erythema. typically occurs in adults, appearing as red pustules on the face. erythema multiforme: A skin disorder characterized by bulls-eye-shaped lesions that can be triggered by an infection or some medicines **When erythema multiforme is coded, code the associated manifestation, an additional adverse effect code if drug induced, and an additional code from L49.- to identify the percent of skin exfoliation. erythema nodosum: reddish, painful, tender lumps most commonly located located in a part of the fatty layer of skin on the front of the legs below the knees.

To code for destruction of malignant lesions (codes 17260-17286), the ____________ of the lesion is measured.

diameter

nondystrophic nail

essentially a normal nail unaffected by abnormal development or changes in structure or appearance due to disease, injury, or aging.

Autologous graft (15769-15774) harvested with the liposuction technique is reported based on the cubic centimeters of _______________

fat injected.

The most common mammary dysplasia?

fibrocystic disease or mammary cysts; noncancerous changes that give a breast a lumpy or ropelike texture. Fibrocystic changes in breasts are common and are often a diagnosis associated with an E/M code or breast exam.

Common bacterial skin infections- ICD ch. 12

impetigo: a highly contagious skin infection that is caused by bacteria entering the skin, typically through cuts or insect bites. Causes red sores on the face and mainly affects infants and children. folliculitis: common skin condition in which hair follicles become inflamed. L02 cutaneous abscesses, furuncles: a boil; a painful, pus-filled bump under the skin caused by infected, inflamed hair follicles. typically are caused by a staphylococcal infection. L02 carbuncles: A group of boils forming a connected area of infection under the skin. They often occur on the back of the neck, shoulders, or thighs. typically are caused by a staphylococcal infection. L02 cellulitis: A common and potentially serious bacterial skin infection; the bacteria enter the skin and may spread rapidly. Affected skin appears swollen and red and may be hot and tender. L03 lymphangitis: inflammation of the lymphatic vessels that connect the lymph nodes. L03 lymphadenitis: lymph nodes that usually enlarge in response to a bacterial or viral infection. L04 pilonidal cyst: An abnormal skin growth located at the tailbone that contains hair and skin. L05

Intermediate repair codes (12031-12057)

include repair of epidermis, dermis, or subcutaneous tissues requiring layered closure of one or more of the subcutaneous tissues and nonmuscle fascia. includes limited undermining. also considered intermediate repair is a single-layer closure of a heavily contaminated wound that requires extensive cleaning or removal of particulate matter.

Complex repair codes (13100-13160)

include repairing of wounds requiring at least one of the following: exposure of bone, cartilage, tendon, or named neurovascular structure; debridement of wound edges (for example, traumatic lacerations or avulsions); extensive undermining; involvement of free margins of helical rim, vermilion border, or nostril rim; or retention sutures. Necessary preparation includes creation of a limited defect for repairs

Melanoma

is a malignancy and a more serious skin cancer Melanoma is measured in thickness known as Breslow's depth, and is determined by the pathologist during examination. This measurement is related to the five-year survival rate after surgical intervention.

What is the dermis?

is under the epidermis and performs most of the skin's functions made up of two layers: the upper or papillary layer and the lower or reticular layer.

Open wounds include:

lacerations, puncture wounds, and bites

Avascular

lack in blood supply, devitalized, necrotic, and nonviable. Specific types include slough and eschar.

Bulla

large blister

Procedures involving the ankle are reported with codes that include in the code descriptor.

leg

For certain repairs (CPT® codes 12001-12018; 12031-12057; 13100-13153), the ____________ of the wound is measured in centimeters.

length

when more than one classification of wound is repaired, ______________

list the more complicated repair first, followed by the less complicated repair add CPT® modifier 59 to each procedure after the first

What is subcutaneous tissue?

located under the dermis primarily fat cells that give the skin a smooth appearance and acts as a cushion. *subcutaneous tissue is not a layer of the skin but is just below the skin.

Nail debridement

may be indicated for hypertrophic (enlarged) dystrophic nails, mycotic (fungal) infections, or for patients with peripheral vascular disease (due to atrial blockage/lack of circulation) typically performed mechanically by using instruments such as a nail splitter, nail elevator (small, narrow spoon-shaped instrument), and electrical burr or sander.

Elliptical Excision

method of excision to fully remove a malignant lesion: The physician usually marks the skin externally before the first incision is made. The length of the ellipse is usually two to three times the required width. The incision is through the dermis with some subcutaneous fatty tissue visible when the tissue is excised.

Electrodesiccation

method of excision to fully remove a malignant lesion: destroys tissue using a small instrument with a cautery needle connected to a monopolar electric source. Electricity is the source of heat as it passes through cautery blade or needle. As the needle touches tissue, the tissue is burned away (destruction).

Electrofulguration

method of excision to fully remove a malignant lesion: destroys tissue using high frequency electric current. An insulated electrode with a metal point is held above the surface of the lesion while electrical sparks are generated in sufficient quantity to destroy the tissue. After a layer of cells is destroyed, it is scraped away with a curette (small, sharp, ring-shaped instrument). This method results in a wide border of normal tissue being removed along with the malignant lesion (destruction).

NSTI

necrotizing soft tissue infection; in debridement, physician removes the necrotic eschar tissue to allow for proper healing of the site.

What is the epidermis?

outermost portion of skin

The excision of a nail and nail matrix (11750)

performed for severely deformed or ingrown nails. This procedure may be performed using surgical, laser, electrocautery, or chemical techniques, following administration of a local anesthetic.

wedge excision of the skin of the nail fold

performed to treat an ingrown toenail. performed when there is a chronic infection resulting in diseased tissue along the nail fold. The physician makes an incision along the nail fold and a wedge-shaped excision is performed to remove the diseased tissue. In most cases the wound is left open to heal by secondary intention.

Process used when patient presents with a hematoma (collection of blood) of the fingernail or toenail

physician removes the collection of blood using an electrocautery unit to pierce the nail plate and drain the fluid

Actinic Keratosis (AK)

premalignant lesion that has a slow-developing thickening and scaling due to chronic sun exposure

bed sore

pressure ulcer

debridement

process of removing dead tissue or eschar, dirt, foreign material, or debris from infected skin, a burn, or a wound to promote healing and prevent or control infection Debridement codes in the Integumentary System section are used more often for friction burns, frost bite, abrasions, pressure ulcers and more, ***but are not used for second and third degree burns of the skin Pay close attention to the body area that is being treated and how much tissue, muscle, or bone is being debrided from that body area.

What is keratin?

protein that stiffens epidermal tissue to form finger nails *nails grow from a thin area called the nail matrix, at an average rate of one mm per week.

Primary wound healing

refers to healing of a clean incision via collagen synthesis. Wounds, which are easily repaired by bringing the wound edges together with minimal tissue loss, are said to heal by primary intention.

Surgical repair

refers to procedures reestablishing function or appearance of damaged tissue through artificial means. often involve suturing tissues back together after they have been separated or damaged by injury or trauma.

punch biopsy

removal of a small core of tissue using a hollow punch

shave removal of a lesion

removal of the lesion without taking a full thickness excision. Reporting of shave removals is by body area and size

External cause codes

report how the burn or corrosion occurred, and where (for example, while cooking in the kitchen).

If repairs involve nerves, blood vessels, or tendons, the appropriate code would be

selected from the correct system (nervous, cardiovascular, or musculoskeletal, respectively). A simple exploration of the nerves, blood vessels, or exposed tendons is considered part of the repair.

All excised lesions include ____________ repair

simple

For other repairs (for example, full-thickness grafts) (CPT® codes 14000-14302 and 15100-15261) the ____________________ is measured in square centimeters based on the size of the recipient site.

size of the graft

what are the 2 primary layers of the skin?

the epidermis and the dermis.

primary defect

the original defect (operative wound) to be closed.

Dehisced/Dehiscence

to split apart or open along natural or sutured lines.

Other diseases of skin and subcutaneous tissue- ICD ch. 12

urticaria: hives and shows on skin as raised, red, itchy wheals that varies in shapes and sizes. Urticaria can be caused by an allergy to food or medications, external factors such as heat or friction, or can be idiopathic. *The ICD-10-CM code is selected based on the cause of the urticaria keratosis: overgrowth of the horny layer of skin. Actinic keratosis (AK) is also known as solar keratosis and is caused by exposure to sun. It appears as a scaly, crusty lesion on the skin, sometimes resembling a wart. Actinic keratosis is known as precancerous: it can be the first step leading to squamous cell carcinoma and is reported with code L57.0, along with an *additional code to identify the source of ultraviolet radiation. Seborrheic keratosis is a benign growth typically not forming into cancer and is coded from category L82. Warts are also a growth on the skin typically caused by human papilloma virus (HPV) and are often benign growths. Warts caused by HPV are reported with B07.9. disorders of skin appendages (L60-L75): diagnosis for nail conditions, hair conditions, and other subcutaneous skin conditions. One of the main diagnoses seen in diseases of the nail is an ingrown toenail (L60.0): caused when the skin on the side of the nail is pressed against the nail itself, typically by tight fitting shoes. This pressure causes the skin to become irritated, red, and painful. Alopecia (category L63) is loss of hair, also referred to as balding. Alopecia areata is an autoimmune disease where the immune system mistakenly attacks hair follicles, causing hair loss. Telogen effluvium is alopecia caused by a metabolic or hormonal stress or by medications. Code selection is based on the type of alopecia. corns and callosities (L84): the body's way of adding protection to the skin. They typically are a result of constant friction to an area of the skin. pressure ulcers (L89): lesion on the skin caused by superficial loss of tissue, also known as a bedsore or decubitus ulcer and occurs when there is loss of tissue due to pressure on the skin, commonly located over bony prominences, such as the hip. In ICD-10-CM, skin ulcers are selected based on the type (for example, diabetic, amebic), the site and, if a pressure ulcer, the stage. In ICD-10-CM, each site has a code choice for unstageable pressure ulcers. Unstageable is not the same as unspecified. Unstageable means the base of the ulcer is covered in eschar or slough and the depth of the ulcer cannot be determined. Unspecified means the physician has not specified the stage of the ulcer. ***Be sure to review ICD-10-CM chapter guidelines regarding pressure ulcers (ICD-10-CM guideline I.C.12.a.). hypertrophic scars/keloid scar (L91.0): excess growth of connective tissue during the healing process after surgery requiring a cut to the skin or after an injury to the skin

Injection of filling material such as collagen

used in many facets of reconstructive and cosmetic surgery. The physician injects filling material subcutaneously to treat acne scars, facial wrinkles, and abnormality of the breast due to reconstruction.

Simple repair codes (12001-12021)

used on superficial wounds that primarily involve the epidermis, dermis, or subcutaneous tissues without involvement of deeper structures. The repair requires simple one-layer closure/suturing and includes local anesthesia and chemical or electrocauterization of wounds not closed. When adhesive strips are used as the only material for wound closure, only an E/M service should be reported.

Lesions are measured by their _____________ , while repairs are measured by the length, width, and depth of the wound.

widest diameter

the nail consists of:

· Nail root: the portion of the nail under the skin · Nail body: the visible pink portion of the nail—the white crescent at the base of the nail is the lunula; the hyponychium secures the nail to the finger; the cuticle or eponychium is a narrow band around the proximal edge of the nail · Free edge: the white end extending past the finger