Pediatric Coding Alert

When a child's mother is working overseas, you can now explain the family disruption thanks to ICD-9 2010's expansion of the V61.0 category.

"Pediatricians spend a significant amount of time counseling and coordinating care related to family issues," says Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville. "Often, this represents time-based coding, which can be supported with the 2009 and 2010 new additional codes for family disruption." Take a look at the specifics of the new 2010 ICD-9 codes in this valuable family disruption series.

Question 1: A father brings his daughter in complaining that she's been acting out at home and in school. During the course of the encounter, he shares that the mother left two months ago to work a one-year law assignment in Dubai. Is there a code that explains this family disruption?

Answer 1: Yes, ICD-9 2010 creates V61.08 (Family disruption due to other extended absence of family member). Before Oct. 1, you would have had to code the above example with V61.8 (Other specified family circumstances), saysRebecca Lopez,  CPC, with the billing and coding compliance department of Bright Health Physicians in Whittier, Calif. "This new code is helpful in being more specific."

You already had a code for an individual or family affected by a family member on military deployment (V61.01). Under family disruption (V61.0x), you'll also have new code V61.07 (Family disruption due to death of family member).

You can use the V61.0x codes when a family member's absence or death affects a patient's health or is the reason for seeking or receiving medical advice or care,according to ICD-9. The American Academy of Pediatrics (AAP) requested an expansion of category V61.0 to more carefully monitor these circumstances: "Unfortunately, in today's society, there are many circumstances that lead to disruption in family. The specific circumstances can affect how the physician may have to deal with the patient and manage any ongoing problems," according to the "ICD-9-CM Coordination and Maintenance Committee Meeting March 19-20, 2008, Diagnosis Agenda" (www.cdc.gov/nchs/data/icd9/agendaMa08.pdf).

Tip: If counseling dominates the disruption encounter, you could code the scenario based on time and link the office visit code (99201-99215) to the disruption code, such as V61.01. You could also report any signs or symptoms or behavioral issues.

CPT lets you code an office visit using time as the controlling factor when counseling and/or coordination of care makes up more than 50 percent of the visit's total faceto-face time. Include the visit's total time, the counseling time, and a "brief synopsis of the discussion," says Suzan Berman (Hvishdash), CPC, CEMC, CEDC, senior manager of coding and compliance for UPMC in Pittsburgh.

Question 2: Because Jane is dealing with her brother who is a drug addict, she is losing weight and has insomnia. What ICD-9 2010 codes should you use?

Answer 2: You would code the primary problems of weight loss (783.21, Loss of weight) and insomnia (780.52, Insomnia unspecified). Since the addict sibling is a contributing factor, you would report the family disruption as an additional or third diagnosis with V61.42 (Substance abuse in family).

Code V61.42 is appropriate when a patient is having ill effects due to a family member who is abusing substances. The AAP proposed this code because "use of illegal drugs or drug abuse by a family member can have an adverse effect on other members of the household",

according to the March 2008 ICD-9-CM Coordination and Maintenance Committee Meeting Diagnosis Agenda.

Having a specific substance abuse code will allow better tracking of these specific circumstances. You previously had to lump a substance abuse in family health problem as an "other" health problem using V61.49 (Health problems within family; other).

ICD-9 2010 lets you specifically indicate substance abuse in family with V61.42. You can use the code as the first listed or as an additional diagnosis, according to ICD-9.

Be careful: Don't include an alcoholic sibling or parent in V61.42. You would instead use ICD-9's specific code for that circumstance: V61.41 (Alcoholism in family).

Question 3: A mother brings in her adopted daughter who has been refusing to talk to her mother, saying, "You're not my real mom." Is V61.29 (Parent-child problems; other) which includes "problem concerning adopted or foster child" the best choice in the V61.2x category?

Answer 3: If this claim's date of service is before Oct. 1, 2009, when the ICD-9 2010 became effective, V61.29 is the correct code. For claims dated Oct. 1 and later, you instead should use V61.24 (Counseling for parent-adopted child problem).

Don't miss: Revisions to V61.2 let you specify two additional parent-child relationships. For child problem counseling when the child is the parent's biological child,use V61.23 (Counseling for parent-biological child problem). If the child is in foster care, go with V61.25 (Counseling for parent [guardian]-foster child problem).

The three new codes allow better monitoring of problems between adopted children and parents, or foster children and parents, according to the AAP's proposal for revisions to V61.2 (Parent-child problems).

Space-saver: If your charge ticket is jammed packed, consider including a short version of V61.2x with a line for the pediatrician to specify the relationship. For instance, you might include an entry of: V61.2x, Counseling for parent-child problem; Relationship: _________.