ED Coding and Reimbursement Alert

Zone in on the terminology and symptoms that will help you code accurately

ICD-10 Focus: Zika 

ICD-10's October 2015 debut brought higher levels of specificity for reporting all types of injuries and diseases. But when emerging infectious diseases, such as the Zika virus, come on the scene, choosing the most appropriate ICD-10 code is a challenge for clinicians and coders alike.

USA Today reports that public health officials are increasingly concerned about the Zika virus' potential impact on the United States. The New York Times reports that the mosquito that carries the Zika virus is present in 30 states, more than twice what officials originally thought. The virus is a real threat and you'll need to be ready to accurately report Zika presentations.

Understand the Medical Lingo

Zika is in the flavivirus group of RNA viruses which are primarily transmitted by bites from mosquitos or ticks, says, Sarah Todt, RN, CPMA, CPC, CEDC, Director, Provider Education & Audit for LogixHealth, a national coding and billing company in, Bedford, MA. Other flaviviral emerging diseases with similar presentations include Dengue and Chikungunya. Symptoms of these infections are similar and include: fever, rash, arthralgia, myalgia and headache. Zika also has associated conjunctivitis while Dengue has shock and hemorrhage. Guillian-Barre syndrome and fetal microcephaly have been implicated with Zika virus, she adds.

There is No ICD-10 code for Zika Yet

Currently there is no specified ICD-10CM code for Zika virus and until there is a specific code available coders can use 92.8 (Other specified mosquito-borne viral fevers) when appropriate.

Good news: Expect a Zika virus code in the October 2016 ICD-10-CM update - A92.5 (Zika virus disease). But don't start using this code until it's officially released on Oct. 1.

What If Zika is Suspected, But Not Confirmed?

Patients with Zika viral illnesses may present with symptoms other than fever such as: maculopapular rash, arthralgia, conjunctivitis, headache and myalgia. The symptoms should be reported when the disease is not confirmed, Todt explains.

Check Out These Clinical Vignettes From Todt

Clinical vignette 1: A 36-year-old presents to the emergency department with complaint of fever, myalgias and conjunctivitis. The patient reports recent travel to Brazil and multiple mosquito bites. The patient is fully evaluated and is diagnosed with Zika viral fever.

ICD-10-CM: A92.8 (Other specified mosquito-borne viral fevers)

Clinical vignette 2: A 22-year-old presents to the emergency department with complaints of myalgia, headache and arthralgia. The clinician suspects Zika but it is not confirmed.

ICD-10-CM: M79.1 (Myalgia), R51 (Headache), M25.50 (Pain in unspecified joint).

Remember, it's not appropriate to use a Zika virus code when the condition is unconfirmed.

Zika In a Pregnant Patient Adds an Additional Medical Concern and an Additional Code

Diagnosis reporting for illnesses associated with pregnancy adds another layer of complexity. The Zika virus has been linked to a broad array of birth defects throughout a long period of pregnancy, including premature birth and blindness in addition to the smaller brain size caused by microcephaly, according to The Centers for Disease Control (CDC).

For patients diagnosed with Zika during pregnancy, report O98.5XX (Other viral diseases complicating pregnancy, childbirth and the puerperium). Indicate the trimester with the final digit; 1 for first trimester, 2 for second trimester, and 3 for third trimester.

Clinical vignette 3: A 27-year-old patient who is eight weeks pregnant presents to the emergency department with complaints of fever, maylgias and headache. She reports recent travel to Panama. A complete evaluation is performed and the patient is diagnosed with Zika viral fever.

ICD-10-CM: O98.511 (Other viral diseases complicating pregnancy, first trimester) and A92.8 (Other mosquito-borne viral fevers).

Bottom line: Always report diagnoses to the highest level of specificity. With newly emerging infections such as Zika virus, rely on existing ICD-10-CM codes until the new, more specific codes become available, says Todt.

ICD-10 Coding for Flaviviruses

ICD-10 Description
A92.8 (Other specified mosquito-borne viral fevers [use for ZIKA])
A90  (Dengue fever [classical dengue])
A91  (Dengue hemorrhagic fever)
A92.0 (Chikungunya virus disease)
O98.511 (Other viral diseases complicating pregnancy, first trimester)
O98.512 (Other viral diseases complicating pregnancy, second trimester)
O98.513 (Other viral diseases complicating pregnancy, third trimester)

ICD-10 Coding for symptoms and associated conditions

ICD-10 Description
R50.9 (Fever, unspecified)
R21  (Rash and other nonspecific skin eruption)
M79.1 (Myalgia)
M25.5* (Pain in joint) * use code for specific joint when appropriate
R51         (Headache)
G61.0 (Guillain-Barre syndrome)
Q02  (Microcephaly)