Pediatric Coding Alert

Warning:  Pause before reporting bronchitis for a child

See if you're up to speed on the new ICD-9 diagnoses effective Oct. 1, 2006, with this three-part quiz.

Don't Listen to Rumors About V Code Listing

Before we focus on the ICD-9 changes for 2007, let's dispel one common V code misconception:

Question 1: True or false. Certain V codes cannot be used as primary codes.

Answer 1: False. It's a little-known fact: The talk circulating about some V codes not being primary codes is wrong. V codes can be used in the primary position.

The misconception partially stems from the ICD-9 manual. In the ICD-9 book, some V codes have a red box with the white letters "SDx" next to them, which indicates the code is a secondary code only. "But the designation applies for inpatient Medicare coding only," says Jeffrey F. Linzer Sr., MD, FAAP, FACEP, associate medical director for Compliance and Business Affairs at EPG ...quot; Children's Healthcare of Atlanta at Egleston. For a code specification to be valid, the instruction must appear in the ICD-9 definition, Linzer says.

The designations stem from Medicare's "Unacceptable Principal Diagnosis" edit. Effective Oct. 1, 2006, CMS will add to this list the new attention-to-dressings V codes.

Codes V58.30 (Encounter for change or removal of nonsurgical wound dressing), V58.31 (Encounter for change or removal of surgical wound dressing) and V58.32 (Encounter for removal of sutures) will appear in the ICD-9 2007 manual as "SDx" codes. But you can still use these codes as primary in the outpatient setting.

The designations are a big source of confusion. "Payers may interpret them as rules and sometimes incorporate them into their edits," says Victoria S. Jackson, practice management consultant with JCM Inc. in California.

Be savvy: If an insurer disallows using V58.30-V58.32 as the primary diagnosis with an office visit code (such as 99211 or 99212, Office or other outpatient visit for the evaluation and management of an established patient ...), inform the representative that "the term 'unacceptable primary diagnosis' only applies when used as the primary diagnosis for inpatient Medicare services," Linzer told the audience during "Pre-Conference Workshop II: Pediatric Power Coding: Comprehensive A-Z" at the Pediatric & Ob-Gyn Coding & Reimbursement Conference 2006 in Naples, Fla. "Don't let payers play off your ignorance," he said.

Unique Dx Helps Get to Root of Bronchospasm Px

Many physicians are miscoding bronchospasm. Are you one of them?

Question 2:  Starting Oct. 1, I will report acute bronchospasm as:

a. 519.1--Other diseases of trachea and bronchus, not elsewhere classified

b. 490--Bronchitis, not specified as acute or chronic

c. 519.11--Acute bronchospasm

d. 493.02--Extrinsic asthma; with (acute) exacerbation

Answer: C. ICD-9 2007 will introduce a specific code for acute bronchospasm. You should use this code "when a child presents with bronchospasm but has not been diagnosed with asthma," according to the American Academy of Pediatrics request for a nonasthmatic bronchospasm code as cited in the ICD-9-CM Coordination and Maintenance Committee Meeting on April 1, 2005.

Some physicians are coding acute bronchospasm as bronchitis. But reporting the symptom of bronchospasm may be a more accurate ICD-9 diagnosis at the time of the visit.

Prior to Oct. 1, 2006, you should have been using 519.1. "Many other conditions are indexed to this code including abscess of bronchus, atrophy of trachea, bronchostenosis and calcification of bronchus," the ICD-9 agenda notes say. Having a unique code for bronchospasm will allow better tracking of the condition's chronicity or recurrence, which will aid in better diagnosing the child's underlying problem.

This Digit Reveals Seizure's Future Impact

Not all complex febrile seizures are the same.

Question 3: Complete the sentence: After Sept. 30, 2006, when I code a complex febrile seizure, I should differentiate whether the child is __________.

Answer: at risk for developing complications. ICD-9 2007 will allow you to identify whether a seizure puts a child at risk for developing complications in the future (780.32, Complex febrile convulsions), Linzer says. "When a child suffers a seizure with no increased risk of complications, use 780.31," which will be revised to "febrile convulsions (simple), unspecified."