Pediatric Coding Alert

Surprise: You could benefit from a new V code

The ICD-9 code additions that will most impact pediatrics haven't been solidified yet, but here's a sneak peak at what could be in store.
 
Four new ICD-9 code changes could be available to you this fall. "A few pediatric-specific codes were heard at the March ICD-9 Coordination and Maintenance Committee," but there wasn't time to include the extra codes in the proposed rule, says Jeffrey F. Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance and business affairs at EPG in Egleston, Ga. This October, at least one of these changes -- all in the conditions in the perinatal period subsection -- will take effect:

 • new code for hypoxia and birth asphyxia -- 768.7 , Hypoxic-ischemic encephalopathy (HIE)

 • two new codes describing other respiratory problems after birth:
 770.87 -- Respiratory arrest of newborn
 770.88 -- Hypoxemia of newborn

 •  addition of a fifth-digit subclassification under "other transitory neonatal endocrine and metabolic disturbances specific to the fetus and newborn" (now 775.8)
  
1. to describe "other acidosis of newborn" (775.81), which will also note:
         • acidemia NOS of newborn
         • acidosis of newborn NOS
         • mixed metabolic and respiratory acidosis of newborn 
 
2. replacement of 775.8 with 775.89 (Other neonatal endocrine and metabolic disturbances specific to the fetus and newborn) to include "amino-acid metabolic disorders described as transitory"

 • introduction of a code under "other specified conditions originating in the perinatal period" (779.85) for "cardiac arrest of newborn."

Reason: Since some of the above "conditions can exist during the perinatal period but are unrelated to the birthing process, additional changes were recommended to accommodate these conditions, unrelated to the birth process," according to the March 23-24 ICD-9-CM Coordination and Maintenance Committee meeting.
 
The American Academy of Pediatrics and ob-gyn representatives recommended the changes "because of the need to correctly identify these potentially devastating conditions accurately."

Code Family History to Justify Adolescent Colonoscopy

 While the verdict is still out on the perinatal-period code changes, Linzer points out another section of codes that you can look forward to. The 2007 update gives you more codes for a family history of digestive disorders.

This October, you can use a fifth digit on V18.5 to indicate that a patient has a family history of colonic polyps (V18.51) or other digestive disorders (V18.59). These codes will be especially useful because a patient may have a test or study only because of a personal history of disease.
 
"We haven't had a lot of great ways to describe this in the past, and these new V codes are going to be a great help," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, coding manager for the University of Washington's physician group in Seattle.
 
Example: Because an adolescent has a history of colonic polyps, you order a colonoscopy for the patient. "Normally, an adolescent wouldn't require this procedure," Linzer says. Using the diagnosis of family history of colonic polyps helps justify the procedure.