Pediatric Coding Alert

Avoid these soon-to-be-taboo codes this October

If you've been looking for a clearer way to indicate postnasal drip, generalized pain, or torsion of the epididymis, ICD-9 2007 ends your search with several new diagnosis codes, which take effect Oct. 1.
 
Although you'll confront more than 200 new codes this fall, we'll save you time by identifying the changes that will have the biggest impact on your coding. One pediatrician gives you the skinny on the new ICD9 Codes that he plans to use in his general pediatric practice . "Many more might occasionally be used (once or twice a year), but for those infrequent times, it isn't worth clogging a cheat sheet/quick reference plaque," says Charles A. Scott, MD, FAAP, pediatrician at Medford Pediatric & Adolescent Medicine PA in Medford, N.J.
 
Reminder: HIPAA does not allow a grace period for implementing the new codes, so you need to know the newbies and update your superbills by Sept. 30.

Benefit From Codes for Postnasal Drip, Bronchospasm

Acute postnasal drip can be a big cause of irritation for patients, says Heather Corcoran, coding specialist at CGH Billing in Louisville, Ky.
 
Example: A child has a postnasal drip, but the pediatrician doesn't diagnose the patient with allergies. You now end up with a potential payment problematic "other" code (784.9, Other symptoms involving head and neck). But ICD-9 2007 will allow you to pinpoint the symptom with specific code 784.91 (Postnasal drip). This is a good diagnosis for general pediatric practices to add to their cheat sheet, Scott says. The "other" code will also morph into a fifth-digit code: 784.99 (Other symptoms involving head and neck).
 
Another new code your practice may find useful is 519.11 (Acute bronchospasm). ICD-9 2007 separates out acute bronchospasm and identifies it as a separate and distinct condition, says Carol Pohlig, BSN, RN, CPC, at Hospital of the University of Pennsylvania in Broomall. That's a big change from the current two-tiered approach.
 
"You have to identify it as a general acute component of another condition (such as acute exacerbation of bronchiolitis, emphysema, bronchitis, COPD, etc.) or lump it into the general category (519.1, Other diseases of trachea and bronchus) if no other disease process is present," Pohlig says.
 
Don't forget: To avoid denials when you do have to use the other code, starting Oct. 1 add a fifth digit of 9 to the current "other code." In other words, 519.1 will become 519.19.

Better Support Services With New Symptom Codes

The ICD-9 manual will also allow you to pinpoint "generalized pain." Now you have to lump this symptom under generic code 780.99 (Other general symptoms). Starting in October, you'll be able to use 780.96 (Generalized pain), says Susan Vogelberger, CPC, CPC-H, CMBS, owner and president of Healthcare Consulting & Coding Education LLC (HCCE) in Boardman, Ohio. This code will be useful when a pediatrician "has a patient complaining of pain but cannot be more specific," she says.
 
The march toward specificity continues with more options that get you out of the taboo "other" or "other specified" zone. "I always like it when ICD-9 offers more specific signs and symptoms," says Kathy Pride, CPC, CCS-P, director of consulting and training for QuadraMed in Reston, Va. "It helps to support the medical necessity of diagnostic tests and exams." Look for these additional opportunities to better describe a patient's symptom.
 
Opportunity 1: You'll be able to avoid another "other" code when a pediatrician orders an MRI of the brain due to altered mental status. Now you have to use 780.99 (Other general symptoms) to explain this procedure. Starting in October, you'll be able to use 780.97 (Altered mental status), says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies in Powder Springs, Ga.
 
Opportunity 2: New symptom codes will also exist to describe additional urination abnormalities. Indicate urinary hesitancy (788.64) and straining on urination (788.65) with specific codes, rather than an "other" code (788.69).
 
Another option: If you've searched for a way to differentiate complex febrile convulsions from febrile convulsions, ICD-9 2007 holds the ticket. This fall you can indicate "complex febrile convulsions" with 780.32.

These Peds Sections Will Require Another Digit

Each year, ICD-9 turns numerous four-digit codes into more specific five-digit codes, and 2007 is no exception. The following nuggets highlight four of these chapter-specific changes.
 
Blood and blood-forming organs: Neutropenia was covered under agranulocytosis (288.0), but now it has its own codes (288.00-288.09), including cyclic neutropenia (288.02) and drug-induced neutropenia (288.03). The update also adds 11 other codes for white blood cell count disorders (288.4-288.69). General pediatricians will primarily be concerned with the unspecified code 288.00 (Neutropenia, unspecified), Scott says.
 
Another white blood cell disease also comes out from hiding among other specified diseases. You'll be able to pinpoint leukocytosis with individual codes, such as 288.60 (Leukocytosis, unspecified), rather than using the other specified code 288.8 (Other specified disease of white blood cells).
 
Genitourinary system: If a pediatric surgeon performs an appendectomy along with another procedure, you often can't justify billing separately for the appendectomy. But now you'll be able to use the new codes for torsion of the appendix (608.23-608.24) to describe the reason for the extra appendectomy, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, coding manager for the University of Washington's physician group in Seattle. Codes that are now lumped under 608.2 (Other disorders of male genital organs; torsion of testis) that you should zoom in on this fall include:
 
• 608.20 -- Torsion of testis, unspecified
 
• 608.23 -- Torsion of appendix testis
 
• 608.24 -- Torsion of appendix epididymis.

Injury and poisoning: ICD-9 2007 also adds a fifth digit to code 995.2 for unspecified drug adverse effect. The six new codes will allow you to identify unspecified effects of insulin (995.23), other drug allergy (995.27) or other substance (995.29), as well as requiring a "0" for effects of an unspecified substance (995.20).
 
"Prior to the creation of these new adverse effect codes, reactions to and effects of these types of drugs were generalized, assigning them to the same unspecified code (995.2)," Pohlig says. Benefit: "It always helps coders and insurers when a condition can be reported to the highest level of specificity."