Understanding Excoriation of Skin (also known as Skin Picking Disorder, Dermatillomania, or Neurotic Excoriation)? This resource provides information for healthcare professionals on clinical documentation and medical coding for Excoriation Disorder. Find details on diagnosis criteria, associated ICD-10 codes (L98.1), and best practices for accurate medical record keeping related to compulsive skin picking and related body-focused repetitive behaviors. Learn about effective treatment options and resources for patients with Dermatillomania and Skin Picking Disorder.
Also known as
Excoriation (of skin)
Skin lesions caused by scratching or rubbing.
Obsessive-Compulsive Disorder
Characterized by persistent, unwanted thoughts and repetitive behaviors.
Diseases of the skin and subcutaneous tissue
Encompasses various skin conditions, including infections and inflammatory disorders.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the excoriation due to a physical condition (e.g., insect bites, scabies)?
Yes
Code the underlying physical condition causing the excoriation. Do NOT code L98.1.
No
Is it psychogenic excoriation, repetitive picking/scratching?
When to use each related code
| Description |
|---|
| Recurrent skin picking resulting in lesions. |
| Obsessive-compulsive disorder with various obsessions/compulsions. |
| Body-focused repetitive behavior focused on hair pulling. |
Coding excoriation without specifying the affected body site leads to inaccurate documentation and claims.
Excoriation may be secondary to other conditions (e.g., eczema). Accurate diagnosis is crucial for proper coding and treatment.
Lack of documentation clarifying the severity (mild, moderate, severe) impacts code selection and reimbursement.
Q: How can I differentiate between Excoriation Disorder (Skin Picking) and other conditions presenting with similar skin lesions, such as obsessive-compulsive disorder (OCD) or body dysmorphic disorder (BDD)?
A: Differentiating Excoriation Disorder from OCD and BDD can be challenging due to overlapping symptoms. While all three involve repetitive behaviors and potential distress, the core focus differs. In Excoriation Disorder, the primary focus is on the act of skin picking itself, leading to skin lesions. In OCD, the focus is on reducing anxiety associated with intrusive thoughts or compulsions, and skin picking, if present, is often a response to these obsessions (e.g., contamination fears). BDD centers around a perceived flaw in appearance, where skin picking may occur in an attempt to "fix" the perceived defect. Consider exploring the patient's primary motivation and the function of the behavior when making a differential diagnosis. Assess for the presence of obsessions and compulsions characteristic of OCD or preoccupations with perceived flaws in appearance suggestive of BDD. Learn more about diagnostic criteria for these conditions in the DSM-5-TR to aid in accurate diagnosis and treatment planning.
Q: What are the most effective evidence-based treatment approaches for adults with Excoriation (Skin Picking) Disorder, including both pharmacological and non-pharmacological interventions?
A: Evidence-based treatment for Excoriation Disorder includes both pharmacological and non-pharmacological approaches. Habit reversal training (HRT), a specific type of cognitive behavioral therapy (CBT), is considered the first-line non-pharmacological treatment. HRT involves increasing awareness of picking behaviors, identifying triggers, and developing competing responses to replace skin picking. Acceptance and commitment therapy (ACT) has also shown promise in helping individuals manage the emotional distress associated with skin picking urges. Pharmacologically, selective serotonin reuptake inhibitors (SSRIs) and N-acetylcysteine (NAC) have demonstrated some efficacy in reducing skin picking behavior. Consider implementing a combination of HRT and pharmacological interventions for optimal outcomes. Explore how different treatment modalities can be tailored to individual patient needs and preferences.
Patient presents with excoriation disorder, also known as skin picking disorder, dermatillomania, or neurotic excoriation. The patient exhibits repetitive and compulsive skin picking resulting in visible skin lesions. The patient acknowledges the recurrent picking behavior and repeated attempts to decrease or stop skin picking. The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies). The skin picking is not better explained by symptoms of another mental disorder (e.g., body dysmorphic disorder, trichotillomania). Differential diagnosis includes obsessive-compulsive disorder, body-focused repetitive behavior, and other self-injurious behaviors. Assessment includes evaluation of the frequency, duration, and severity of skin picking, triggers and associated behaviors, and impact on quality of life. Treatment plan may include cognitive behavioral therapy (CBT), habit reversal training (HRT), acceptance and commitment therapy (ACT), andor pharmacotherapy such as selective serotonin reuptake inhibitors (SSRIs). Prognosis and treatment response will be monitored through ongoing clinical evaluation and patient self-monitoring. ICD-10 code L98.1 and DSM-5 criteria were used for diagnostic confirmation. Medical necessity for treatment is established based on the documented impairment and distress related to the excoriation disorder.