John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

John R. Tkach, M.S., M.D.
Diplomate of the American Board of Dermatology
300 North Willson, Suite 203B
Bozeman, Montana 59715
Phone (406) 587-5442

The skin is a mirror that reflects what is going on in the mind and the body.

September 23, 2015

Dear Doctor

I want to share with you my Dermatology ICD-10 coding list. I have been working on this since April. I have probably spent 100 hours or more on trying to make useful sense of Dermatology ICD-10 coding. I worked on it every spare minute. Karl Elzey's training programs have been most helpful.

I have found Dermatology ICD-10 coding and ICD-10 coding in general to be somewhat looney. For example, there is no tabular code for skin tags. ICD-10 calls them epidermal thickenings.

ICD-10 uses strange terms that I have never heard such as: There is an ICD-10 code for acquired keratosis pilaris, Q85.8. But, there is no ICD-10 code for inherited keratosis pilaris, the autosomal dominant keratosis pilaris that is what we see every day. That is called lichen pilaris. Who calls it that? The closest I can find is Q82.8 which also is used for keratosis palmaris et plantaris. How can those two very different conditions have the same ICD-10 code?

There is no myxoid cyst of the finger. By looking at a 42 year old copy of Rook, I found focal mucinosis (L98.5), which is as close as I can come. And the problems go on and on.

There are many gaps and inconsistencies. It is a nightmare of oppressive obsessive/compulsive personality disorder. Some areas are listed in excessive detail and others are handled very superficially.

To code these yourself, you need 5 indexes several of which are 1,200 and 1,600 pages each. None is easy to use. A great number of these codes cannot be used directly. You need to take into account exclusions and special rules which can be found with difficulty in the 1,600 page tabular list. Good luck hunting for them.

The old General Equivalency Code Mapping (GEM) appears to have been replaced with more detailed but still dangerously incomplete categories module. This new module lacks pointers to exclusions and special rules.

There is no grace period here. When the clock hits midnight Oct. 1, bam, we are forced to use only ICD-10 coding.

CMS sent a letter that they will be lenient for the 1st year. What that tells me is that they cannot train their own people to do ICD-10 coding monitoring right. They are panicked. The Blues announced they intend to be strict right at the start and will require the 7th character, with no grace period. I predict that next they will do CPT revisions.

I hope this list will be useful. The way to use this list is:

  1. If your software will allow you to enter the ICD-10 code directly, just enter it from my list.
  2. If your software forces you to search for the ICD-10 code number in order to enter it, you can use the known code to locate a data enterable code. Use the code to find the code. Sounds stupid? You'll see.

Warmest greetings,

Jack Tkach, M.D.

View Dr. Tkach's ICD-10 Dermatological Codes list.