Pediatric Coding Alert

Don’t ignore these often-overlooked diagnosis codes.

Submitting claims for your pediatric visits can get tricky when it feels like none of the diagnosis codes apply to your claim, or you need to support your diagnoses by explaining secondary reasons for your visit. Read on for three common myths and how using ‘E’ and ‘V’ codes can help your coding cause.

Myth 1: No Codes Apply to Screenings

When the patient has no signs or symptoms and you perform a test solely for screening purposes, you’ll sail past typical diagnosis codes since none of them apply—but that doesn’t mean your claim is going to sink. Locate an applicable “V” code to describe the test to the payer so you can get your claims paid. Although some practices haven’t ventured beyond V20.2 (Routine infant or child health check) in the ICD-9 book, the reality is that V codes have plenty to offer beyond that code.

Sequence: List the screening code first if the reason for the visit is specifically the screening exam, states the ICD-9-CM Official Guidelines for Coding and Reporting. Report the screening code as an additional code, however, if the provider performs the screening during an office visit for other health problems.

For example, the pediatrician screens a patient for hyperlipidemia and hypercholesterolemia. Include V77.91 (Screening for lipoid disorders) on your claim. 

If the screening returns an abnormal result, then code those results as an additional diagnosis.

Myth 2: When A V Code Isn’t Primary, Don’t Use It

Although you’re accustomed to assigning V20.2 as a primary diagnosis code, not all V codes will serve that same purpose. In fact, you can’t use just any V code as a primary diagnosis code; some are exclusively secondary codes. 

You should use V codes as secondary and tertiary diagnosis codes to further explain how a patient’s symptoms or condition originated. For example, there are V codes to indicate follow-up (V67.59, Follow-up exam; following other treatment; other; V67.9, Unspecified follow-up examination; and V72.8x, Other specified examinations). Typically, carriers prefer that you list the primary diagnosis, e.g., otitis media (382.9), first and list V67.59 second, for the follow-up visit.  

Next year: Under ICD-10, you’ll have a slightly different opportunity for coding follow-up visits. First, you would code Z09 (Encounter for follow-up examination after completed treatment for condition other than malignant neoplasm.). Second, you would use an additional code to identify applicable history of disease such as Z86.xx-Z87.xx. So for follow-up of otitis media as in the example above, you’d report Z09 and Z87.898 (Personal history of other specified conditions) because there isn’t one that’s specific to otitis media, or even to ENT codes.

Myth 3: E Codes Can Be Listed As Primary Dx Codes

Accidents do happen--and when it comes to treating pediatric patients, they happen frequently. Round out your diagnosis coding for accidental injuries by adding optional ‘E codes’ to your ICD-9 roster, and you can speed up your claims processing.

When reporting accidental injuries, poisonings and late effects of injuries, you should remember to use the supplemental E codes listed in ICD-9-CM, when appropriate, to fully document the medical justification for the visit. E codes are not required, and are never listed as the primary diagnosis, because they only identify the circumstances of an accidental injury. However, you may use the E code, and often more than one E code, to fully describe circumstances or establish medical necessity.

Example 1: A child falls from a playground jungle gym and presents to the office complaining of pain in her lower left arm. You evaluate the child and determine that the arm is only bruised, but not broken or sprained. You also evaluate the child for other injuries and report a 99213 for the visit.

A diagnosis code for a contusion of the forearm (923.10) should be listed as the primary diagnosis. But some payers might question the E/M level for the workup because the diagnosis is not specific. However, if this code were reported in addition to E884.0 (Accidental fall from playground equipment) and E849.4 (Accidents occurring in place for recreation and sport), the payer would have information justifying workup and, possibly, x-rays to check for a fracture or more severe injury.

Other common optional pediatric E codes include the following, among others: 

• E826.1 (Pedal cycle accident injuring Pedal cyclist) for a patient who falls off of his bike.
• E883.0 (Accident from diving or jumping into water [Swimming pool]) for a patient who gets hurt jumping into a pool
• E884.4 (Accidental fall from bed)
• E885.2 (Accidental fall from skateboard)
• E900.0 (Accident caused by excessive heat due to weather conditions) for sunstroke
• E905.3 (Venomous animals and plants as the cause of poisoning and toxic reactions; hornets, wasps, and bees) for reactions to bee, hornet or wasp stings 
• E906.0 (Dog bite)
• E917.0 (Striking against or struck accidentally by objects or persons; In sports without subsequent fall) if a patient is hit by a thrown ball or kicked during a sports game
• E920.4 (Accidents caused by cutting and piercing instruments or objects; Other hand tools and implements) if a patient is cut with a pair of scissors or a sewing needle

Remember that these codes will be changing under ICD-10, which takes effect Oct. 1, 2015.