Pediatric Coding Alert

Time to find out if you’re a Chapter 5 ace.

Once you’ve answered the quiz questions on page 3, compare your answers with the ones provided below:

Answer 1

The main difference between R63.0 (Anorexia) and conditions found in the F50.0- (Anorexia nervosa) codes is that “R63.0 documents an unexplained or unknown loss of appetite, while the anorexia nervosa codes describe psychological development disorders where the patient fears becoming overweight and develops a distorted self-image of the body to the point of starvation or malnutrition,” explains Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/ credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California.

Answer 2

Using F90.0 (Attention-deficit hyperactivity disorder, predominantly inattentive type) to document a patient diagnosed with attention deficit disorder (ADD) without hyperactivity would be incorrect. That’s because the code specifically mentions hyperactivity in its descriptor, which is not a part of the patient’s diagnosis.

Instead, “if you look in the ICD-10 index under ‘disorder, attention-deficit without hyperactivity [adolescent] [adult] [child],’ you are directed to F98.8 [Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence],” says Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

Answer 3

To find the right code for the anxiety depression diagnosis in the question, you need to examine the similar-sounding synonyms that accompany two specific codes: F41.8 (Other specified anxiety disorders) and F34.1 (Dysthymic disorder).

Code F41.8 lists “Anxiety depression (mild or not persistent)” as a synonym, while F34.1 has “persistent anxiety depression” listed as a synonym for the condition. As the provider has documented that the patient has experienced the condition repeatedly over the course of time, this suggests the “persistent” synonym accompanying F34.1 makes this code the most accurate way to report the condition.

Answer 4

To answer this question, you need to understand the clinical similarities between the conditions. “Bipolar disorder is easily confused with depression because it can include depressive episodes. The main difference between is that depression is unipolar, meaning that there is no ‘up’ period, but bipolar disorder includes symptoms of mania,” Holle explains.

Or, as the AHA ICD-10-CM Coding Clinic explains it, “bipolar disorder includes both depression and mania.” Because of that, the article goes on to say, “it is more important to capture the bipolar disorder,” so “a code for depression would not be reported separately” (Coding Clinic 2020, Vol 7, No. 1).

This is reinforced by the instructions for all the bipolar and major depressive episode codes, which state that the F32.- (Major depressive disorder, single episode) and F33.- (Major depressive disorder, recurrent) codes are Excludes1 codes for the F31.- (Bipolar disorder) codes, and that the F31.- codes are Excludes1 codes for the F32.- and F33.- codes.

So, in this situation, you would only report a bipolar disorder code. However, a definitive answer to this question becomes more complicated when you consider the numerous code choices in the F31.- category. The codes are divided into various subcategories depending on whether the patient is currently experiencing the condition (the F31.0 - F31.6- codes), whether the patient’s condition is in remission (the F31.7- codes), whether the patient is experiencing other forms of the condition (the F31.8- codes), or whether the condition is unspecified (F31.9).

Then, each of these conditions are subdivided by different characteristics: severity (mild, moderate, severe, or unspecified); hypomanic; with or without psychotic features; with depression; or with various mixed features.

With so many code possibilities in play, then, the final answer to the question relies on you “querying your pediatrician so that you can code to the highest level of specificity,” Holle cautions.

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