# ICD-10 code for changed name of a diagnosis



## ronaldgfell (Jul 6, 2016)

Hello to all,
recently a Pediatric Physician asked me if there was an ICD-10 code for the new diagnosis that is being used (Brief Resolved Unexplained Event) as a replacement for the previously used diagnosis of Apparent Life Threatening Event (R68.13).
They are presenting a paper on this and need also to know if there is not a code for it currently and or is it proposed for ICD-11>
Anyone who has any information on this please let me know.
Page 236 in ICD10 book says "Event", apparent life threatening in newborn and infant (ALTE) R68.13.

Thanks so much.
Ron


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## mitchellde (Jul 6, 2016)

There may be a code for ICD-10 but the US is using ICD-10 CM.  ICD-11 also will not be used in the US so we will wait for ICD-11 CM, which may take years (I have read possibly 2025). Codes in ICD-10 are not necessearily reflected in ICD-10 CM.  the list for the 2017 revision to ICD-10 CM was released last Friday and there is no revision to the current R68.13 in this list.  ICD codes may be updated twice a year, so that means April1 and Oct 1.  The Committee will meet in November to determine if there will be any April updates and we will know after that meeting.  That is all I can tell you for now.


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## Cynthia Hughes (Jul 7, 2016)

*Diagnosis of BRUE*

I have been looking at this topic and the new guidelines from the American Academy of Pediatrics do address coding.  "The authors of this guideline recommend that the term ALTE no longer be used by clinicians to describe an event or as a diagnosis. Rather, the term BRUE should be used to describe events occurring in infants younger than 1 year of age that are characterized by the observer as “brief” (lasting <1 minute but typically <20–30 seconds) and “resolved” (meaning the patient returned to baseline state of health after the event) and with a reassuring history, physical examination, and vital signs at the time of clinical evaluation by trained medical providers. For example, the presence of respiratory symptoms or fever would preclude classification of an event as a BRUE. BRUEs are also “unexplained,” meaning that a clinician is unable to explain the cause of the event after an appropriate history and physical examination. Similarly, an event characterized as choking or gagging associated with spitting up is not included in the BRUE definition, because clinicians will want to pursue the cause of vomiting, which may be related to GER, infection, or central nervous system (CNS) disease. However, until BRUE-specific codes are available, for billing and coding purposes, it is reasonable to apply the ALTE International Classification of Diseases, 9th Revision, and International Classification of Diseases, 10th revision, codes to patients determined to have experienced a BRUE..." The guideline also indicates that new codes need to be developed for lower-risk and higher-risk BRUE.

Of note, is that an event is only a BRUE if there is no other likely explanation. An event in an older child or of greater than 1 minute duration would not be reported as BRUE. Symptoms or observation codes (Z03-Z04) and after October 01 (Z05) may be reported as indicated. Unfortunately, we may not see new codes and coding guidance until Oct. 01, 2017. 

Hope that is helpful.
Cindy


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