Pediatric Coding Alert

A patient with asthma or diabetes always has that condition when he comes to your office, but that doesn't mean you should always list it on the claim. Find out when to report a pre-existing condition by asking two questions:

You don't need to code the chronic condition every time a patient with one presents for an office visit (99201-99215, Office or other outpatient visit ...). "If the condition doesn't affect treatment, you don't need to code it," says Deborah Grider, CPC-EMS, CPC-H, CPC-P, CCS-P, president of the American Academy of Professional Coders (AAPC) National Advisory Board.

Example: A pediatrician diagnoses a diabetic patient with otitis media (OM) and places her on an antibiotic. Because the physician has to consider how the systemic illness will interact with the diabetes, you can code diabetes (250.01, Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled) in addition to the OM diagnosis (such as 381.01, Acute serous otitis media).

To determine what diagnosis code to list first, ask "Why now?" How it works: "You avoid the problem of diabetes being the first diagnosis when it's not the immediate reason for the visit," suggests Nancy Reading, RN, BA, CPC, AAPC educational services director.

Example: A 9-year-old established patient with diabetes presents for evaluation of his extrinsic asthma that seems to be exacerbated by the recent prolonged wet weather. The pediatrician also orders a pulmonary function test to check the patient's respiratory status and checks his blood sugar levels to evaluate his diabetes and insulin regimen. You would code the diabetes second (250.02) because it is not the main reason for the visit, Grider instructs. Report the asthma (493.02, Extrinsic asthma; with [acute] exacerbation) as the primary diagnosis.