ED Coding and Reimbursement Alert

Contact with and suspected exposure codes are also relevant in Ebola outbreaks

Ebola Virus cases have been everywhere in the news recently and focusing a lot of attention of emergency departments. The medical team has to get the diagnosis right to appropriately treat the patient and prevent widespread exposure to the community. As a coder, you must get the diagnosis code right, as well, for both tracking purposes and accurate payment for services rendered.

Consider this scenario: A 42 year-old health care worker comes to the ED because of a low grade fever. He had recently returned from a medical mission where he was caring for patients who had Ebola Virus Disease (EVD). There are no other symptoms and the patient is medically stable. Based on current Centers for Disease Control and Prevention and your local health department’s guidelines, the patient will be admitted to a special quarantine unit. What diagnosis codes should you use for the ED encounter?

While fever is one of the early signs of EVD, there may be causes of the patient’s fever other than Ebola, and he is not demonstrating any other clinical findings that would be consistent with the infection, says Jeffrey Linzer Sr., MD, FAAP, FACEP, Lead Physician for ICD-10-CM Transition Core Leadership Team at Children’s Healthcare of Atlanta. 

What to report: Based on the highest level of clinical certainty at the time the patient is in the ED, the principal diagnosis would be 780.60/R50.9 (Fever unspecified) with a contributing diagnosis of V01.79/Z20.828 (Contact with and [suspected] exposure to other viral communicable diseases) for the potential Ebola exposure. If there was a known contact with infected body fluids, then V15.85/Z77.21 (Personal history of contact with and [suspected] exposure to potentially hazardous body fluids) could also be listed Linzer explains.

How About A“Feared Exposure” Diagnosis?

What about the case where the patient wants to be evaluated because she had been in an EVD endemic area, does not have any signs or symptoms and was cleared to be discharged? 

In this situation, the principal diagnosis would be V71.83/Z03.818 (Observation and evaluation for suspected exposure to other biological agent). You’ll use this diagnosis when there is a concern that the patient could have been infected but has no signs or symptoms, and the condition is not found to be present, says Linzer. The secondary diagnosis would also be V01.79/Z20.828 (Contact with and [suspected] exposure to other viral diseases) for the potential Ebola exposure, he adds.

While there is a unique code in ICD-10-CM for Ebola, A98.4, coders will need to use the non-specific 065.8 (Other specified arthropod-borne hemorrhagic fever) while ICD-9-CM is in effect, says Linzer.