June 25, 2019

Coder Knowledge: UV Awareness & Skin Cancer

Next month is designated as UV Safety Awareness Month which comes as no surprise.  July is the month of summer vacations, trips to the beach, summer sports and outdoor yard work. 

Did You Know? 

Skin cancer is more and more common.  In fact, according to the American Cancer Society it has become the most frequently diagnosed form of cancer in the U.S.  The Skin Cancer Foundation notes that every year there are “more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.”

Contributing factors

  1. Skin is the largest organ in the human body.
  2. The UV index is changing due to a diminished ozone layer.
  3. Patient awareness lags other, more publicized cancers.

Basal cell and squamous cell carcinomas are the most common forms of skin cancer, melanoma has the highest mortality rate. Skin cancer can be caused by too much exposure to ultraviolet (UV) rays from the sun and other sources, such as tanning beds and sun lamps. 

However, the good news is we can take highly preventative measures to decrease our risk.  During UV Safety Month, make it your practice to follow the index levels and associated protection recommendations. 

UV Index Recommended Protection
Extremely High (11+) Sunscreen, sunglasses, hat, shade, indoors from 10 a.m. until 4 p.m.
Very High (7-10) Sunscreen, sunglasses, hat, shade
High (6-7) Sunscreen, sunglasses, hat, shade
Medium (3-5) Sunscreen, sunglasses, hat
Low (0-2) Sunscreen, sunglasses

Coder Knowledge: Cell Type Matters

Clinical coding of skin cancers is based on two key factors: the type of cell involved and the anatomical site.  As mentioned above basal and squamous sell are the most common.  These types of skin cancers are often treated topically in the physician’s office and require minimal coding expertise.  However, melanoma is more invasive, and treatment typically includes a hospital encounter with radical wide excision, skin grafts, and lymph node excision.

Example Chapter 2 Index

        C44.11 Basal cell carcinoma of skin of eyelid

                  C44.111 Basal cell carcinoma of skin of unspecified eyelid

                   C44.112 Basal cell carcinoma of skin of right eyelid

                   C44.119 Basal cell carcinoma of skin of left eyelid

        C43.1   Malignant Melanoma skin of eyelid

                    C43.10 Malignant melanoma of unspecified eyelid

                    C43.11 Malignant melanoma of right eyelid

                    C43.12 Malignant melanoma of left eyelid

In ICD-10-CM, body sites are specific to site and type of skin cancer.  They require documentation of laterality for paired organs such as ears, eyes and upper and lower limbs. Physician documentation is key to specificity.

Denise Bell, CCS