Pediatric Coding Alert

While it's highly unlikely that you will have a case of anthrax in your office, you have been told to be on the alert. You are more likely to see anxious parents who want to ask about anthrax and find out how to protect their children. You may even have cases of possible exposure that require antibiotics. Some basic coding tips can help pediatricians navigate this uncharted territory.
Diagnosis Codes
You must select a diagnosis code, the key to payment for the E/M visit, based on (a) whether the child was exposed to anthrax and (b) whether the child has symptoms.
 
1. Negative exposure, negative symptoms. The child who has no possible exposure and no symptoms has no need for treatment. In one scenario the mother is near hysteria and wants you to confirm that her child "doesn't have anthrax." Probe as to why she thinks the child might have anthrax. Was he or she in a contaminated building? Does he or she have an odd skin lesion or flu symptoms? A "yes" answer will lead to a useful diagnosis code.
 
If the mother insists that the child has no exposure or symptoms, code V65.5 (other persons seeking consultation without complaint or sickness; person with feared complaint in whom no diagnosis was made), says Tom Kent, CPC, CMM, president of Kent Medical Management, Dunkirk, Md. The "worried well" diagnosis code will probably not be paid by the family's insurance plan. Regardless of what you do during this visit you may spend 15 minutes talking to the mother about anthrax, for example you should use the worried well diagnosis code.
 
If you are very uncomfortable about coding "worried well," use V71.9 (observation and evaluation for suspected conditions not found; observation for unspecified suspected condition), recommends Jeffrey Linzer, MD, FAAP, AAP representative to the ICD-9 editorial advisory board.
 
2. Negative exposure, positive symptoms. If the child has symptoms not necessarily of anthrax, which is difficult to diagnose in the early stages, but of anything code the symptoms, Linzer says. Possible symptoms include upper-respiratory infection (465.x, acute upper respiratory infections of multiple or unspecified sites; 487.1, influenza; with other respiratory manifestations), skin bump (782.2, symptoms involving skin and other integumentary tissue; localized superficial swelling, mass, or lump) or cough (786.2, symptoms involving respiratory system and other chest symptoms; cough).
 
You may even have enough information to be sure the diagnosis is flu; code 487.1 in the primary slot and the symptom (786.2 for cough) in the secondary slot.
 
3. Possible exposure, negative symptoms. If the child has no symptoms but has been exposed to anthrax, do not use V65.5 (worried well). Instead, use V01.8 (contact with or exposure to communicable diseases; other communicable diseases) as [...]