ICD-10 Coding for Fungal Infections

Hi everyone and welcome to our podcast series. My name is Natalie Tornese and I’m a Senior Solutions Manager with Outsource Strategies International. I wanted to take this opportunity to talk to you about fungal infections. What are they?

Fungal infections occur when a harmful fungi takes over an area of the body, which is too much for the body’s immune system to handle.  Fungi lives everywhere in the air, soil, water, plants. There are also some fungi that live naturally in the human body. Killing a harmful fungus is very difficult when they invade the human body as they can survive in the environment and re-infect the person who is trying to get better. Fungal infections often start off in the lungs or on the skin when the fungal spores (often present in the air or in the soil) come into contact with the skin or are inhaled. A person is more likely to get a fungal infection if he/she has a weakened immune system or takes antibiotics. If diagnosed quickly and appropriately treated, spreading of these infections can be controlled. However, from a provider’s point of view, proper documentation by the physician specifying the type of fungal infections as well as their symptoms and associated complications is essential for proper code selection. 

Who is Prone to Fungal Infections?

They are common among people who –

• Have a genetic predisposition toward them, or are born with a weakened immune system and include children, elderly people, people suffering from HIV infection, cancer, diabetes
• People who are obese and have excessive skin folds
• People who sweat heavily (since sweaty clothes and shoes can enhance fungus growth on the skin)
• People who come in contact with a person suffering from a fungal infection, and
• People that take antibiotics

Most common types of fungal infections and their related symptoms include-

• Athlete’s foot which is a common fungal infection that affects the foot. Athlete’s foot can cause peeling, redness, itching, burning, and sometimes even blisters and sores. The infection is more common during the summer and warm, humid climates, where the fungus can quickly multiply. It occurs more often in people who wear tight shoes and socks, use sports equipment, and commonly use community baths and pools.
• Jock itch is similar. It is caused by the same type of fungus which thrives in moist areas of the body such as the groin, buttocks, and inner thighs. The infection is mildly contagious and often spread through direct contact with an infected person or an object that is carrying the fungus. Those symptoms include redness, itching, burning sensation in the infected areas, cracking, flaking, or dry peeling of the skin in the infected area, and rashes with a circular shape and raised edges.

These things actually cause another a common form of Candida overgrowth in women, usually caused by a yeast-like fungi called “candida”. It occurs due to stress, hormonal imbalances, poor eating habits and consumption of antibiotics. This non-contagious infection is more common among people who are obese or have diabetes. The immediate signs and symptoms are – itching, swelling around the vagina; redness and soreness on the surrounding area of the vagina, burning sensations or pain during urination or intercourse and unusual vaginal discharge.

• Ringworm is a skin infection caused by a fungus that lives on dead tissues, such as the skin, hair, and nails. This type of infection can appear anywhere in the body and appear like a circular, red, flat sore, which is often accompanied by scaly skin. It is highly contagious and can be transmitted by skin-to-skin contact, from contact with pets, even such as dogs.

Diagnosis and Treatment for Fungal Infections

It is important to consult a dermatologist or a general practitioner. The physician will ask about your symptoms and medical history, and will perform a detailed physical exam. In most cases, physicians will try to identify the type of infection based on the appearance of the skin rashes or reported symptoms. They will ask patients about their possible exposure to people or animals with similar infections. In addition, skin scrapings or samples from the infected area are taken, examined, inspected under microscope to identify the presence of any fungus.

Treatment for these fungal infections may be based on the type of infections and severity of the symptoms a person suffers from. In most cases, physicians may prescribe topical anti-fungal medications and oral drugs. Over-the-counter or prescription creams may be prescribed for more severe cases.

There are certain ICD-10 codes that need to be used when billing for something like this. The diagnosis codes must be documented for all procedures that are performed. I’ll include a transcript from this podcast that will highlight some of those diagnosis codes.

Taking adequate preventive actions can help avoid fungal skin infections in the long run. It is important to consult a dermatologist or general physician at the very first sign of infections to avoid serious complications. Early identification of symptoms helps in better treatment.

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. Thank you so much for listening!