ED Coding and Reimbursement Alert

Under ICD-10, you’ll need to check the chart to correctly assign that 7th character for the most accurate code choice.

Expanding the diagnosis code set from a maximum of five characters in ICD-9 to seven characters in ICD-10 allows for specificity in the areas such as laterality and episode of care for pediatric patients. 

Consider these pediatric laterality crosswalk examples from Eryn Lukic, CCS-P, CPC, CEDC, AHIMA ICD-10 Trainer and Associate Director, Coding Operations at LogixHealth in Bedford, Massachusetts.

1. Diagnosis:  otitis media, left ear

ICD-9-CM:  382.9, Unspecified otitis media

ICD-10-CM:  H66.92, Otitis media, unspecified, left ear

2. Diagnosis: corneal foreign body, right eye, initial encounter

ICD-9-CM: 930.0, Corneal foreign body

ICD-10-CM:  T15.01XA, Foreign body in cornea, right eye, initial encounter

3. Diagnosis: left wrist pain

ICD-9-CM:  719.43, Pain in joint involving forearm

ICD-10-CM:   M25.532, Pain in left wrist 

Watch A, D, and S for Episodes of Care

Coders also need to be aware of three areas for correctly assigning peds episodes of care codes. The ICD-10 rules identify the following episodes: initial (A), subsequent (D), sequela (S), Lukic points out. Below are some examples highlighting the additional specificity involved in coding the episode of care in ICD-10 when compared to ICD-9: 

1. Diagnosis:  nondisplaced bimalleolar fracture right ankle, healing, subsequent encounter

ICD-9-CM:  V54.16, Aftercare for healing of traumatic fracture of lower leg

ICD-10-CM:  S82.844D, Nondisplaced bimalleolar fracture of right lower leg, subsequent encounter for closed fracture with routine healing

2. Diagnosis: burn, right hand first degree, initial encounter

ICD-9-CM:  944.10, Erythema due to burn (first degree) of unspecified site of hand 

ICD-10-CM:   T23.101A, Burn of first degree of right hand, unspecified site, initial encounter

Transition E Codes to W Codes for Falls Injuries

One of the major expansions in ICD-10 is the category used to report external causes of morbidity (formerly classified as E-Codes in ICD-9).  Many of the injuries that are treated in the ED, for a pediatric population, are related to injuries as a result of a fall.  ICD-10 expands the code set to allow for very specific reporting of causes of injury as well as the episode of care.  Some common external cause codes (previously not specified in ICD-9) that would be reported in a pediatric ED setting are as follows:

1. Previously reported using ICD-9 code E884.0 (Accidental fall from playground equipment):

W09.2XXA: Fall on or from jungle gym, initial encounter

W09.1XXA: Fall from playground swing, initial encounter

2. Previously reported using ICD-9 code E884.9 (Other accidental fall from one level to another):

W14.XXXA:  Fall from tree, initial encounter

W17.81XA: Fall down embankment (hill), initial encounter 

Easy Crosswalk for Common ED Peds Dxs

Good news: Not all of your common peds conditions require complex transitioning. Many of the diagnoses that are commonly reported in the ED for a pediatric population are a simple crosswalk from ICD-9 to ICD-10, says Lukic. Below are some example diagnoses coded in both ICD-9 and ICD-10 to illustrate ease of the crosswalk.

Check Out These Dx Coding Vignettes 

Use these scenarios from Lukic to guide your coding for common pediatric ED encounters.

Vignette 1: While playing in the park, a five-year-old child was bitten by a dog. The patient presents to the ED with an open wound of the right hand and lip. While in the ED the physician cleaned and sutured the wounds.  

The following ICD-9-CM codes would be assigned:

873.43:  Open wound of lip, uncomplicated

882.0:  Open wound of hand except fingers, alone, without complication

E906.0: Dog bite

E849.4:  Accidents occurring in place for recreation and sport

The following ICD-10-CM codes would be assigned:

S01.501A:  Unspecified open wound of lip, initial encounter

S61.401A: Unspecified open wound of right hand, initial encounter

W54.0XXA:  Bitten by dog, initial encounter

Y92.830:  Public park as the place of occurrence of the external cause

Vignette 2:  A two- year- old male presented to the ED with shortness of breath, ear pain and a fever of 101.3.  The patient has a history of asthma.  Upon examination of the patient, the physician orders a chest x-ray and notices the patient has pneumonia of the left lobe. It is also found that the patient has otitis media of the right ear.  The final diagnoses for the visit are documented as: pneumonia, otitis media, and acute exacerbation of asthma. 

 The following ICD-9-CM codes would be assigned:

486:  Pneumonia organism, unspecified

493.92: Asthma, unspecified, with (acute) exacerbation

382.9: Otitis media, unspecified

The following ICD-10-CM codes would be assigned:

J18.9: Pneumonia, unspecified organism

J45.901: Unspecified asthma with (acute) exacerbation

H66.91: Otitis media, unspecified, right ear.