Documenting and Coding Six Common Diabetes-Related Skin Disorders

Diabetes is considered a fast-growing, chronic disease affecting millions of people. According to recent reports, more than 25 million people in the US suffer from diabetes. The condition can affect many parts of the body, including your skin. About one-third of people with diabetes will develop skin problems either related to or influenced by this condition. Most of the diabetes-related skin complications are harmless, but some can result in painful and persistent symptoms, which may require medical attention. The most effective treatment option for many diabetes-related skin conditions is effective blood sugar management. Proper control of your blood glucose level can help prevent diabetes-associated skin problems and many other symptoms from occurring in the first place. In other severe cases, a doctor may prescribe oral steroids, medicated creams, or another treatment. Going to go over some of the skin related disorders along with that come along with diabetes and I have also included a transcript of all associate ICD-10 codes of the conditions that I’ll be talking about.

The first one is Acanthnosis nigricans. It’s a common skin pigmentation disorder characterized by areas of dark, velvety discoloration in body folds and creases. Notable signs of this condition are dark patches of skin with a thick, velvety texture. The patches may appear on skin folds and other areas, such as the neck, groin, armpits, elbows, knees, knuckles, palms and soles of the feet. It’s not a disease but a symptom of another condition that may require medical attention. The skin problem usually strikes people who are overweight. While there is no cure for losing weight may improve the skin condition. And treatment is largely focused on addressing the condition that is causing it. However, if the condition is caused by medications or supplements, your doctor may suggest discontinuing them or recommending substitutes.

Vitiligo is another as a disease that causes the loss of skin color in blotches. This condition occurs when the cells that produce melanin die or stop functioning. It can affect any part of the body and it may also affect the hair and inside of the mouth. It can affect people of all skin types, but is most commonly seen in people with darker skin. Patchy loss of skin color is one of the initial symptoms of the condition and in most cases, the discoloration first shows on sun-exposed areas such as the hands, feet, arms, lips, face and in even the neck. Other related symptoms include  premature whitening or graying of the hair, loss of color in the tissues that line the inside of your mouth and nose, and the loss of or color change of the inner layer of the eyeball. Treatment for vitiligo may restore color to the affected skin, but it does not prevent continued loss of skin color or a reoccurrence. Treatment options are medications and therapies like light therapy, de-pigmentation, skin grafting, micro-pigmentation in severe cases.

(The ICD-10 codes of the diabetes-related skin conditions are –

1. Acanthnosis nigricans
   • L83 – Acanthosis nigricans
2. Vitiligo
   • L80 – Vitiligo
3. Necrobiosis lipoidica diabeticorum (NLD)
   • L92.1 – Necrobiosis lipoidica, not elsewhere classified
4. Eruptive xanthomatosis (EX)
   • E78.2 – Mixed hyperlipidemia
5. Diabetic blisters

• S90.82 – Blister (nonthermal) of foot
  • S90.821 – Blister (nonthermal), right foot
    • S90.821A – Blister (nonthermal), right foot, initial encounter
    • S90.821D – Blister (nonthermal), right foot, subsequent encounter
    • S90.821S – Blister (nonthermal), right foot, sequela
  • S90.822 – Blister (nonthermal), left foot
    • S90.822A – Blister (nonthermal), left foot, initial encounter
    • S90.822D – Blister (nonthermal), left foot, subsequent encounter
    • S90.822S – Blister (nonthermal), left foot, sequela
  • S90.829 – Blister (nonthermal), unspecified foot
    • S90.829A – Blister (nonthermal), unspecified foot, initial encounter
    • S90.829D – Blister (nonthermal), unspecified foot, subsequent encounter
    • S90.829S – Blister (nonthermal), unspecified foot, sequel

6. Granuloma annulare

• L92 – Granulomatous disorders of skin and subcutaneous tissue
  • L92.0 – Granuloma annulare
  • L92.01 – Necrobiosis lipoidica, not elsewhere classified
  • L92.02 – Granuloma faciale [eosinophilic granuloma of skin]
  • L92.03 – Foreign body granuloma of the skin and subcutaneous tissue
  • L92.08 – Other granulomatous disorders of the skin and subcutaneous tissue
  • L92.09 – Granulomatous disorder of the skin and subcutaneous tissue, unspecified

)

The next one is Necrobiosis lipoidica, NLD. It’s a condition related to diabetes, which results in reddish brown areas of the skin, most commonly on the lower legs. The exact cause of this condition is unknown, but its linked to blood vessel inflammation related to autoimmune factors. This damages proteins in the skin. Skin lesions occurring in the forearms are one of the most common symptoms. In some rare cases, these lesions can also occur on the stomach, face, scalp, palms, and the soles of the feet. It is very difficult to treat. Common treatment options include corticosteroid creams/injections, anti-inflammatory medications, medicines that improve blood flow, phototherapy and laser therapy. In severe cases, the lesions may be removed by surgery, followed by grafting skin from other parts of body.

Eruptive Xanthomatosis is another skin condition that causes small, harmless yellow-red bumps to appear on the skin. These bumps are sometimes referred to as lesions, papules, plaques, or a rash. Severe insulin resistance can make it harder for the body to break down fats in the blood. This increases the level of fats in the blood, which can get deposited under the skin and form small bumps. It’s very common among people with poorly-controlled diabetes who have very high triglycerides and high cholesterol. It causes a group of round little bumps, which look like a cluster of small, hard, raised spots. They are usually found on the back of your arms such as around your elbows and on the back of your thighs, buttocks, and legs. In some cases, they can also show up around your eyes and other areas like the stomach, neck, back, knees, scalp and face. These bumps cause symptoms like itching, pain, redness and oozing. Generally, they go away within a few weeks to months.

Diabetic blisters typically occur in people who do not control blood sugar well. They usually clear bumps that have an irregular shape. They are painless and tend to heal on their own without treatment. They most often appear on the legs, feet, and toes and less frequently can show up on the hands, fingers, and arms. This skin problem often occurs in people who have severe diabetes or diabetic neuropathy. Bringing your blood sugar level under control is one of the initial treatments for this skin condition. These blisters have high risk of infection and ulceration. One of the primary ways to prevent the infection is to avoid puncturing or bursting the blisters. They may be treated with antibiotic creams, steroidal creams and bandages to protect them from further injury.

Granuloma Annulare is a skin condition that causes raised reddish or skin-colored bumps that spread outwards in a ring pattern. Bumps often occur on the hands, fingers, and forearms. The National Organization for Rare Diseases note that granuloma annulare may be a common complication of diabetes or shingles, although it is unclear why the bumps develop. The lesions usually disappear on their own within two years without treatment. Treatment options however can include Corticosteroid treatments /ointments/injections, freezing, light therapy and other oral medications which can help the bumps fade faster. Keeping your diabetes under control is one of the best ways to reduce the risk, severity and frequency of skin-related complications of diabetes.

I hope this helps, but always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.