Pediatric Coding Alert

Pediatricians, not sure if they are faced with Munchausen by Proxy (MBP) syndrome, should use the same diagnosis codes they would use for suspected child abuse (995.5x) for the visit. MBP syndrome occurs when a parent or caregiver either lies about or produces symptoms in a child, brings the child to the pediatrician for medical attention, and hides the fact that the parent or caregiver is fabricating or creating the symptoms.

Diagnosis codes in the 995.5x series are appropriate for suspected MBP syndrome because MBP is an extension of child abuse, says Randell Alexander, MD, FAAP, director of the Center for Child Abuse at Morehouse School of Medicine in Atlanta and an expert on MBP. The most relevant ICD-9 codes are 995.50 (child abuse, unspecified), 995.51 (child emotional/psychological abuse), 995.54 (child physical abuse) 995.59 (other child abuse and neglect).

There are also E codes that identify external causes of injury and poisoning (E960-E989). Poisoning is not unusual in cases of MBP. For example, Alexander recounts a case from several years ago in which a child had chronic diarrhea. We tried everything and finally had to put the child on total parenteral nutrition (TPN), he says. But he still had the chronic diarrhea. Only when a nurse saw the mother giving the child something that looked suspicious did the hospital do a complex stool analysis. A laxative was found in the stooland that had been causing the problem. We reported it to child protective services, and the child was put into foster care, says Alexander.

Good Diagnosis Coding

One good source for diagnosis coding for MBP syndrome and other behavior-related disorders is the Diagnostic and Statistical Manual-Primary Care (DSM-PC), published by the American Academy of Pediatrics (AAP), says Richard H. Tuck, MD, FAAP, founding chairman of the AAPs coding and reimbursement committee. This book is essentially a diagnostic and statistical manual (with psychiatric diagnostic codes) for use by pediatricians. By using this book, pediatricians can support more complex disorders and therefore be able to code at a higher level, says Tuck. These diagnoses may call for more complexity in decision-making.

Note: MBP is a rare syndrome, but it gets a lot of publicity when it is discovered.