Otolaryngology Coding Alert

Question: One of my doctors is a pediatric otolaryngologist, and he sees a lot of patients who were born prematurely. I’m trying to find the best diagnosis code (ICD-9 and ICD-10) to indicate a history of premature birth. The patients he sees are toddlers or children who have a history of prematurity, not newborns. When I’ve submitted 765.10, the payer rejects it as an inappropriate diagnosis for the patient’s age. What do you recommend?

Oklahoma Subscriber

Answer: Code 765.10 (Disorders relating to other preterm infants unspecified weight) should be an appropriate diagnosis in this situation. The descriptor includes an “N” for “newborn,” but the diagnosis still fits your scenario. Appeal and fight the denial based on the code descriptor.

Looking ahead: When you begin using ICD-10 in October, 765.10 will correlate with either P07.00 (Extremely low birth weight newborn, unspecified weight) or P07.10 (Other low birth weight newborn, unspecified weight). ICD-10’s Chapter 16 guidelines state that the codes from P07 “are for use for a child or adult who was premature or had a low birth weight as a newborn and this is affecting the patient’s current health status.”