EmailInfected wound with cellulitis
Publication Date: December 2006
ICD 10 AM Edition: Fifth edition
Retired Date: 30/6/2013
Query Number: 2194
Use of T89.0x codes with cellulitis. Does the presence of cellulitis following open wounds indicate that the wound is infected (T89.02)? It would seem that in some cases apparently uncomplicated trauma to the skin can be identified as the precipitant for the cellulitis which can manifest after the initial injury has healed. In these cases is cellulitis considered a separate disease process but still a complication of the open wound (T89.03)?
Please advise on codes to use in the following scenarios.:
1. Patient admitted with cellulitis of the forearm following being scratched by her cat a week previously. The scratches were healing and did not receive attention. The patient was given IV antibiotics, then switched to oral antibiotics and discharged home.
2. Patient admitted with open wound of leg with surrounding cellulitis following walking into a trailer in the dark 2 days earlier. The wound was debrided in theatre and the patient given IV antibiotics for several days, then discharged home on oral antibiotics.
3.Patient admitted with cellulitis of the foot and ankle. On examination the patient was found to have tinea of the toes which was presumed to be the entry point for the infection. The patient was given IV then oral antibiotics and a topical treatment and podiatry attention for the tinea.
4. Patient admitted with cellulitis of the lower leg following being scratched by rose thorns while gardening 2 days previously. The wounds were cleaned and dressed. Dressings were changed every second day and the patient placed on IV then oral antibiotics.
Search details:
I have reviewed ACS 1210 and ACS 1917 and VICC #1793 (May 2002) which advises to use T89.03 for cellulitis following an open wound in the scenario described.
Please advise on codes to use in the following scenarios.:
1. Patient admitted with cellulitis of the forearm following being scratched by her cat a week previously. The scratches were healing and did not receive attention. The patient was given IV antibiotics, then switched to oral antibiotics and discharged home.
2. Patient admitted with open wound of leg with surrounding cellulitis following walking into a trailer in the dark 2 days earlier. The wound was debrided in theatre and the patient given IV antibiotics for several days, then discharged home on oral antibiotics.
3.Patient admitted with cellulitis of the foot and ankle. On examination the patient was found to have tinea of the toes which was presumed to be the entry point for the infection. The patient was given IV then oral antibiotics and a topical treatment and podiatry attention for the tinea.
4. Patient admitted with cellulitis of the lower leg following being scratched by rose thorns while gardening 2 days previously. The wounds were cleaned and dressed. Dressings were changed every second day and the patient placed on IV then oral antibiotics.
Search details:
I have reviewed ACS 1210 and ACS 1917 and VICC #1793 (May 2002) which advises to use T89.03 for cellulitis following an open wound in the scenario described.
Response
VICC members noted that the majority of the wounds referred to in this query are actually scratches which are superficial injuries rather than open wounds. VICC members were of the opinion that the advice is ACS 1210 Cellulitis applies for open wounds only and not superficial injuries such as scratches, however the NCCH will be consulted on this.
In general if the wound is treated, then this should be coded as the principal diagnosis. If the cellulitis is treated and the wound is not, then the cellulitis would be the principal diagnosis. With regards to your scenarios:
1. For this patient, as the underlying cause is a scratch and not an open wound, the cellulitis is the only condition being treated, therefore the cellulitis should be the principal diagnosis:
L03.10 Cellulitis of upper limb
2. This patient has an open wound complicated by cellulitis. As the wound is treated, code the complicated wound code, followed by a code for the cellulitis:
S81.9 Open wound of lower leg, part unspecified
T89.02 Open wound with infection
appropriate external cause codes
L03.11 Cellulitis of lower limb
3. This patient was admitted for their cellulitis. While the tinea was later found to be the point of entry for the infection, cellulitis is not a presenting problem of tinea. For this patient, the cellulitis should be the principal diagnosis and the tinea an additional diagnosis:
L03.11 Cellulitis of lower limb
B35.3 Tinea pedis
4. The documentation for this patient indicates that the scratches may be more than superficial injuries, however if these are documented as scratches, the cellulitis should be the principal diagnosis, followed by the superficial injury as an additional code:
L03.11 Cellulitis of lower limb
S80.7 Multiple superficial injuries of lower leg
appropriate external cause codes
The VICC has received the following advice from NCCH:
The NCCH confirms that the advice in ACS 1210 Cellulitis applies to open wounds only.
The NCCH also agrees with the coding of the scenarios cited.
The VICC also notes that cellulitis is an inflammation of the skin caused by an infection. The presence of cellulitis following an open wound indicates an infected wound therefore the correct code to assign is T89.02 Open wound with infection.
The advice in this query supersedes the advice published in query #1793 in the May 2002 ICD Coding newsletter.
In general if the wound is treated, then this should be coded as the principal diagnosis. If the cellulitis is treated and the wound is not, then the cellulitis would be the principal diagnosis. With regards to your scenarios:
1. For this patient, as the underlying cause is a scratch and not an open wound, the cellulitis is the only condition being treated, therefore the cellulitis should be the principal diagnosis:
L03.10 Cellulitis of upper limb
2. This patient has an open wound complicated by cellulitis. As the wound is treated, code the complicated wound code, followed by a code for the cellulitis:
S81.9 Open wound of lower leg, part unspecified
T89.02 Open wound with infection
appropriate external cause codes
L03.11 Cellulitis of lower limb
3. This patient was admitted for their cellulitis. While the tinea was later found to be the point of entry for the infection, cellulitis is not a presenting problem of tinea. For this patient, the cellulitis should be the principal diagnosis and the tinea an additional diagnosis:
L03.11 Cellulitis of lower limb
B35.3 Tinea pedis
4. The documentation for this patient indicates that the scratches may be more than superficial injuries, however if these are documented as scratches, the cellulitis should be the principal diagnosis, followed by the superficial injury as an additional code:
L03.11 Cellulitis of lower limb
S80.7 Multiple superficial injuries of lower leg
appropriate external cause codes
The VICC has received the following advice from NCCH:
The NCCH confirms that the advice in ACS 1210 Cellulitis applies to open wounds only.
The NCCH also agrees with the coding of the scenarios cited.
The VICC also notes that cellulitis is an inflammation of the skin caused by an infection. The presence of cellulitis following an open wound indicates an infected wound therefore the correct code to assign is T89.02 Open wound with infection.
The advice in this query supersedes the advice published in query #1793 in the May 2002 ICD Coding newsletter.
