ED Coding and Reimbursement Alert

It’s Not Just Your P’s and Q’s That Need Minding Under ICD-10, Keep An Eye On Your A’s, D’s, S’s and W’s To Get the Needed Specificity for Your Diagnosis 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, left ear

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

ICD-9-CM: 930.0, foreign body in cornea

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

3. Diagnosis: left wrist pain

ICD-9-CM: 719.43, wrist pain unspecified

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

Watch A, D, and S for Episodes of Care

Coders also need to be aware of three areas for correctly assigning pedsepisodes 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: right ankle sprain, subsequent encounter

ICD-9-CM: 845.00, unspecified sit of ankle sprain and strain

ICD-10-CM: S93.401D, sprain of unspecified ligament right ankle, subsequent encounter

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

ICD-9-CM: 944.10, first degree 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 (fall from playground equipment):

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

W09.1XXA: fall on or from swing, initial encounter

2. Previously reported using ICD-9 code E884.9 (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 PedsDxs

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, lip, without mention of complication

·         882.0: open wound, hand, without mention of complication

·         E906.0: dog bite

·         E849.4: place of occurrence 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: place of occurrence, publicpark

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, 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.