Pediatric Coding Alert

Add abnormal PKU code, metabolic codes to your encounter sheet

You can avoid rejections for outdated ICD-9 codes if you know when to apply new codes for communicable disease, positive neonatal screening and fatty acid disorders.
 
Private payers may follow Medicare's lead and require you to use ICD-9 2005 codes on claims starting Oct. 1.
 
To make sure you're ready, take the following diagnostic quiz. (For a list of the new codes, see July 2004 Pediatric Coding Alert's article "New V Code Makes Billing Chicken Pox Exposure a Snap.")

Learn These V Codes' Disease-Specific Definitions

ICD-9 2005 continues diagnostic coding's trend toward greater specificity. You'll have three new V codes to identify contact with or exposure to common pediatric diseases. See if you know which new codes apply in these situations:
 
Question 1: A mother is worried that a playmate exposed her 5-year-old immunosuppressed daughter to chicken pox. The pediatrician's examination shows that  the child has no signs or symptoms of the disease. You should assign which ICD-9 code:
 a. V01
 b. V01.7
 c. V01.71
 d. V01.89

Answer 1: C. You should report V01.71 (Contact with or exposure to communicable diseases; other viral diseases; varicella).
 
Reason: The parent brings the child in for varicella contact or exposure.
 
Old way: You previously should have reported V01.7 (... other viral disease).
 
New way: V01.7 requires a fifth digit of 1 to indicate varicella. When payers start using the 2005 codes, systems will reject V01.7 as lacking a digit.

Question 2: After examining an adolescent whose dormmate developed meningitis, a pediatrician finds the patient normal and prescribes prophylactic antibiotic treatment. The correct diagnostic code is:
 a. V01.84
 b. V01.89
 c. V01.83
 d. V01.8

Answer 2: A. Report the encounter's diagnosis as V01.84 (... other communicable diseases; meningococcus).
 
2004 way: Before 2005's introduction of V01.84, you would have to code the encounter with an other specified code (V01.89, ... other communicable diseases). No code for meningitis exposure existed, so you would have correctly classified the adolescent's diagnosis under "contact with another communicable disease."
 
2005 way: You should specifically identify meningitis contact or exposure with V01.84. This code will be very helpful with college meningitis outbreaks.

Question 3: A pediatrician evaluates a patient for E. coli exposure due to an outbreak at a local pool that the child frequents. You should report _________ as the diagnosis. (Fill in the blank.)
 a. V01.89
 b. V01.79
 c. V01.8
 d. V01.83

Answer 3: D. You should report V01.83 as the diagnosis.
 
Old method: You previously would have coded E. coli exposure as another communicable disease (V01.89). ICD-9 2004 contained no specific code for contact with or exposure to E. coli.
 
New method: You can specifically indicate that a pediatrician evaluated a patient for E. coli exposure with V01.83 (... escherichia coli [E. coli]).

Know New Neonatal Screening, Metabolic Codes

Say good-bye to other specified codes for positive PKU results and insulin-resistant diseases. ICD-9 2005 introduces an abnormal lab findings code, several metabolic codes, and a revision of a perinatal code. Prepare yourself for coding these diagnoses with the following three questions:
 
Question 4: A pediatrician counsels a nonsymptomatic neonate's parents on the repercussions of an abnormal PKU test. For the abnormal lab, you should assign diagnosis code:
 a. 796.9
 b. 796.6
 c. 796.4
 d. 796.5
 
Answer 4: B. You should report the abnormal lab findings as 796.6 (Other nonspecific abnormal findings; abnormal findings on neonatal screening).
 
2004 way: Because no specific code existed for a positive PKU test, you would have used 796.9 (... other).
 
2005 way: Now, you can specifically identify the abnormal neonatal screening findings with 796.6, just as you could for an abnormal antenatal screening (796.5, ... abnormal finding on antenatal screening).

Question 5: An adolescent has insulin resistance without elevated blood sugar. The pediatrician diagnoses the patient with carnitine palmitoyltransferase deficiency (CPT1). You should report the diagnosis as:
 a. 277.85
 b. 277.87
 c. 277.89
 d. 277.86

Answer 5: A. You should report the diagnosis with 277.85 (Other specified disorders of metabolism; disorders of fatty acid oxidation), which includes CPT1.
 
What's new: ICD-9 2005 introduces specific codes for fatty acid oxidation (277.84), as well as peroxisomal disorders (277.86) and mitochondrial metabolism disorders (277.87).
 
Good-bye: You should no longer code the three above-mentioned metabolic disorders with other-specified code 277.89 (Other specified disorders of metabolism).

Question 6: A pediatrician diagnoses a newborn with fetal alcohol syndrome. You should report ICD-9 code:
 a. 760.70
 b. 760.71
 c. 760.4
 d. 761.4

Answer 6: B. You should report 760.71 (Noxious influences affecting fetus or newborn via placenta or breast milk; alcohol).
 
Change: ICD-9 now specifies that the 760.x series relates to the newborn or fetus, not to the mother.
 
For a complete list of new, revised, and deleted ICD-9 diagnosis codes, visit www.cms.hhs.gov/medlearn/icd9code.asp. To obtain more information on CMS' decision to eliminate the grace period, download www.cms.hhs.gov/manuals/pm_trans/R95CP.pdf.

 - Information supplied by Jeffrey Linzer Sr, MD, MICP, FAAP, American Academy of Pediatrics representative to the ICD-9-CM editorial advisory board.