Pediatric Coding Alert

Be careful that you don't assume all ICD-9-CM directives come from ICD-9.
 
In the February 2005 Pediatric Coding Alert, the reader question "Code 278.00 May Cause Payment Problems" included an obesity definition: "125 percent over ideal body weight." But the official ICD-9-CM manual did not include that definition. "ICD generally doesn't define a disease or condition," says Jeffrey Linzer Sr., MD, MICP, FAAP, American Academy of Pediatrics representative to the ICD-9-CM editorial advisory board.
 
In addition, you should reserve the diagnosis discussed in the question - 278.00 (Obesity, unspecified) - for when the patient has an active problem. If the patient has a family history of obesity (and the patient is not obese), you should instead use V18.1 (Family history of other endocrine and metabolic diseases), Linzer says. "Use V65.3 (Dietary surveillance and counseling) as an additional code when this service takes place as part of the E/M service."
 
Linzer also pointed out that the February 2005 Pediatric Coding Alert reader question "You May Need 2 Modifiers on Infusion Claims" omitted an E code. "In the example of the child who is vomiting from chemotherapy, you should also code E933.1 (Drugs, medicinal and biological substances causing adverse effects in therapeutic use; primarily systemic agents; antineoplastic and immunosuppressive drugs) as the reason for the vomiting."