ED Coding and Reimbursement Alert

Some are straightforward, others require several steps.

From strep throat to otitis media, you are likely to see infections in your ED on a daily basis. Do you know how to code them? Check these common scenarios and determine if you’d know which codes to report.

Strep Throat

When you see a chart for a patient with strep, your first step is to determine whether the patient has streptococcal pharyngitis or tonsillitis. The following code sets apply to those diagnoses:

• J02.0 —  Streptococcal pharyngitis
• J03.00 — Acute streptococcal tonsillitis, unspecified
• J03.01 — Acute recurrent streptococcal tonsillitis.

The difference between J02.0 and J03.00 can be pinpointed based on the location of the strep – the pharynx vs. the tonsils. For J03.01, the strep must have recurred, which isn’t always easy to determine in the ED. Therefore, J02.0 and J03.00 would most commonly be reported by ED physicians.

If you perform a strep test and it comes back negative for the infection, you cannot report a code for the above range. Instead, you’ll report only the signs and symptoms rather than the strep code.

UTIs

Urinary tract infections (UTIs) are often coded with N39.0 (Urinary tract infection, site not specified), but that isn’t always the right choice – particularly since it refers to “site not specified.”

Look down the listing, and you’ll find other UTIs that not only lead you to codes for this condition when it involves pregnancy, but also for when the condition is in the kidneys or other locations. In addition, not every patient presenting with symptoms of a UTI is ultimately diagnosed with one. You may see patients with the following conditions, among others:

• R30.— Pain associated with micturition
• R33. — Retention of urine
• R35. — Polyuria
• R39.1 — Other difficulties with micturition.

You might also come across a patient with a history of UTIs, which you can code with Z87.440 (Personal history of urinary (tract) infections). All of these could, after testing, result in a definitive diagnosis. But you’ll need to find other codes once your provider pins down the specific UTI.

Complicating the situation, UTIs go by different names, depending on their location in the body. They typically occur in the kidneys (pyelonephritis), the bladder (cystitis), or the urethra (urethritis). In addition to N39.0, coders should look to the following groups or individual codes to quickly narrow down the diagnosis:

• N10 — Acute pyelonephritis
• N30. — Cystitis
• N34. — Urethritis and urethral syndrome
• N99.521 — Infection of incontinent external stoma of urinary tract
• N99.531 — Infection of continent stoma of urinary tract

When selecting the code for this service, you also need to remember the difference between acute (sudden) and chronic (persistent). For instance, if the patient has acute cystitis, you’ll report N30.0- (Acute cystitis), but if the patient’s cystitis is chronic, you’ll report N30.1- (Interstitial cystitis (chronic)) or N30.2- (Other chronic cystitis).

Otitis Media

Coding otitis media (OM) correctly requires you to determine whether to code H65.- (Nonsuppurative otitis media) or H66.- (Suppurative and unspecified otitis media).

When OM involves a discharge of fluid other than pus, it’s considered nonsuppurative. So, for chronic serous otitis media you would code H65.2-, while you would code H65.3- for chronic mucoid otitis media. And you would code H65.11- (Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous)) for acute and subacute exacerbations that involve the discharge of any of these fluids.

If the patient has influenza, measles, scarlet fever, or tuberculosis, you would typically use the primary ICD-10 code for those conditions.

The usual ICD-10 definitions of acute, subacute, chronic, and recurrent all exist in some form throughout the H65-H67 codes. As always, though, you should not code for severity based on previous provider notes. If your ED physician has not documented chronic serous OM, for example, but you see in the medical record that the patient has been seen for serous OM in the past, you cannot make the decision to code H65.2-.

It’s also important to indicate laterality when documenting OM – without that, you would not be coding to the highest level of specificity. But even though the codes do feature fifth or sixth characters to specify laterality, coders need to be careful when assigning them. Some code sets include two different codes for left and right depending on whether the OM is recurrent or not. So, you can code a diagnosis of acute serous OM in the right ear as either H65.01 (Acute serous otitis media, right ear) or H65.04 (Acute serous otitis media, recurrent, right ear) depending on whether or not the OM is recurrent.