1. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. THE COMPLETE DIAGNOSIS CODING SOLUTION THIRD EDITION Chapter 15 Coding Diseases of the Integumentary System 15-1

2. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Outcomes 15.1 Identify the layers of skin and elements of the integumentary system. 15.2 Apply the guidelines for reporting pressure ulcers. 15.3 Distinguish the differences between types of lesions. 15-2

3. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Outcomes (cont.) 15.4 Explain the various types of dermatitis and how to code each accurately. 15.5 Interpret inclusive signs and symptoms of psoriasis. 15.6 Abstract the notes to code disorders of skin appendages. 15-3

4. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms Blister Bulla Carbuncle Cyst Decubitus ulcer Dermis 15-4

5. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Epidermis Furuncle Gangrene Hair Hair follicle Macule 15-5

6. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Nevus Nodule Papule Patch Phalanges Pressure ulcer 15-6

7. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Pustule Scale Skin Subcutaneous Ulcer 15-7

8. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Introduction The integumentary system is more than just your skin. Your nails (fingers and toes) and your hair are also included, as well as sensory receptors, sebaceous (oil) glands, and sweat glands. 15-8

9. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Integumentary System Anatomy The Skin The average person has roughly 2 square yards (5,184 inches) of skin surface area. As the largest organ in the human body, the skin does so much more than just keep all your internal organs covered. Learning Outcome: 15.1 15-9

10. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Integumentary System Anatomy (cont.) The epidermis and the dermis play an important role in protecting the body, including: Shielding internal organs Blocking infiltration of pathogens and water Providing temperature control Maintaining homeostasis Accumulating vitamin D Sensing things through tactile receptors Learning Outcome: 15.1 15-10

11. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Integumentary System Anatomy (cont.) Hair A pigmented, cylindrical filament that grows out from the follicle within the epidermis Nails Protective layers at the end of phalanges Learning Outcome: 15.1 15-11

12. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Integumentary System Anatomy (cont.) Glands Three different types of glands are located within the skin: Sebaceous glands Eccrine glands Apocrine glands Learning Outcome: 15.1 15-12

13. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Integumentary System Anatomy (cont.) Sensory Nerves are a part of the nervous system known as the somatic (relating to the body) sensory system that provides feedback, the sense of touch. Learning Outcome: 15.1 15-13

14. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pressure Ulcers Pressure ulcer—an open wound or sore caused by pressure, infection, or inflammation Decubitus ulcer—skin lesion caused by continuous pressure on one spot, particularly on a bony prominence Learning Outcome: 15.2 15-14

15. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pressure Ulcers (cont.) Four stages of pressure ulcers: –Stage 1 is reddened on the skin –Stage 2 shows visible blisters or open sore –Stage 3 is a crater with damage on tissue below skin –Stage 4 shows damage to the muscle and bone and sometimes tendon and joint damage –Unstageable ulcer is not an unspecified stage Learning Outcome: 15.2 15-15

16. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pressure Ulcers (cont.) Healing Pressure Ulcers will be monitored by a healthcare professional through documentation that will identify the original stage and describe the ulcer “healing.” Learning Outcome: 15.2 15-16

17. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pressure Ulcers (cont.) Presence of Gangrene notice the code first notation beneath the code category L89, Pressure ulcer, to report the code for any gangrenous condition associated with ulcer by using code I96, Gangrene, not elsewhere classified. Learning Outcome: 15.2 15-17

18. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Lesions Skin lesions are categorized as primary or secondary and are pathologically determined to be benign or malignant. Many skin lesions are identified by name or type. Learning Outcome: 15.3 15-18

19. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Skin Lesion Types Cyst Furuncle Papule Nodule Macule Nevus Learning Outcome: 15.3 15-19

20. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Skin Lesion Types (cont.) Patch Bulla Pustule Scale Ulcer Learning Outcome: 15.3 15-20

21. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Malignant Lesions Most skin lesions diagnosed are benign. However, certain skin lesions are pathologically identified as malignant. Learning Outcome: 15.3 15-21

22. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Dermatitis Dermatitis is an inflammation of the skin. There are several types of dermatitis: –Atopic dermatitis (category L20) –Seborrheic dermatitis (category L21) –Diaper dermatitis (category L22) –Allergic contact dermatitis (category L23) –Irritant contact dermatitis (category L24) –Exfoliative dermatitis (category L26) –Dermatitis due to substances taken internally (category L27) Learning Outcome: 15.4 15-22

23. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Psoriasis Identified by epidermal erythematous papules and plaques covered with silvery scales There are several types of psoriasis, including: –Psoriasis vulgaris –Guttate psoriasis –Psoriatic arthritis mutilans Learning Outcome: 15.5 15-23

24. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Disorders of Skin Appendages Nail Disorders Onycholysis Beau’s lines Yellow nail syndrome Learning Outcome: 15.6 15-24

25. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Disorders of Skin Appendages (cont.) Disorders of the Hair Alopecia mucinosa Trichorrhexis nodosa Hirsutism Learning Outcome: 15.6 15-25

26. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Disorders of Skin Appendages (cont.) Glandular Concerns Eccrine Sweat Disorder (Code Category L74) is when the eccrine sweat glands malfunction. One condition is known as focal hyperhidrosis (excessive sweating). Learning Outcome: 15.6 15-26

27. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Disorders of Skin Appendages (cont.) Glandular Concerns (cont.) Apocrine Sweat Disorders (Code Category L75) include bromhidrosis (foul-smelling perspiration, code L75.0) and chromhidrosis (pigmented perspiration, code L75.1). Learning Outcome: 15.6 15-27

28. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Summary With all the advertising about preserving youthful skin, you may forget that the elements of the integumentary system support the ongoing proper function of the body. 15-28