K64.9 - Unspecified hemorrhoids

Clinical Definition

Stevens-Johnson syndrome is a severe, potentially life-threatening mucocutaneous reaction characterized by widespread epidermal detachment affecting less than 10% of body surface area. It typically presents with severe blistering of the skin and mucous membranes.

Documentation Requirements

• Percentage of body surface area affected (must be <10% for SJS)

• Specific areas involved:

  • Mucous membrane involvement

  • Skin lesion locations

• Triggers or causes:

  • Medication reaction

  • Infection

  • Unknown cause

• Acuity (acute, chronic)

• Severity indicators:

  • Temperature

  • Vital signs

  • Systemic involvement

• Associated complications

• Treatment plan initiated

Common Synonyms

• SJS

• Erythema multiforme major

• Toxic skin reaction

• Severe allergic skin reaction

• Drug-induced skin peeling

Coding Conflicts

Excludes1:

• Toxic epidermal necrolysis (TEN)

• Staphylococcal scalded skin syndrome

• Pemphigus
  Excludes2:

• Erythema multiforme minor

Scribing.io Automation

The AI scribe automatically:

• Identifies keywords like "Stevens-Johnson," "mucocutaneous," and "epidermal detachment"

• Calculates body surface area percentages when documented

• Flags medication associations for potential causality

• Captures severity indicators and vital signs

• Links related symptoms like mucositis and conjunctivitis

• Highlights any documented complications for proper coding assignment