Pediatric Coding Alert

It’s not often your pediatrician will see a child with a scratched cornea, but when they do, you will use a code from S05.- (Injury of conjunctiva and corneal abrasion without foreign body). Fortunately, code choice in these encounters is relatively easy, and you will only have to find information in the documentation concerning the eye that has suffered the injury and whether this is an initial or subsequent visit for — or a visit focused on the sequela, or after effect, of — the condition.

Depending on the circumstances, you’ll add a fifth digit for laterality (using 1 for the right eye, 2 for the left, or 0 for an unspecified eye), and a seventh digit for the episode of care (using A for the initial encounter, D for a subsequent encounter, or S for the sequela), along with the sixth-digit placeholder X.

Conjunctivitis

This frequently seen pediatric eye condition is trickier to code because it is “divided into two categories: infectious, which can be viral or bacterial; or noninfectious, such as conditions caused by allergies or a foreign body,” explains Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

Coding alert: Importantly, “if the provider has not stated if it is viral or bacterial, it is important for the coder/biller to query the provider to see what they believe is more appropriate to use,” Holle advises.

Viral: These forms of the condition are coded to the B30.- group. To narrow down the code, your pediatrician will have to order a test to determine which virus has caused the condition:

Adenovirus: Infections caused by adenovirus serotypes 8, 19, and 37 are coded to B30.0 (Keratoconjunctivitis due to adenovirus), while infections caused by adenovirus serotypes 3, 4, and 7 are coded to B30.2 (Viral pharyngo­conjunctivitis). All other adenoviral conjunctivitis conditions are coded to B30.1 (Conjunctivitis due to adenovirus).

Enterovirus: Infections caused by coxsackievirus A24 and enterovirus 70 are coded to B30.3 (Acute epidemic hemorrhagic conjunctivitis (enteroviral)).

Bacterial: The most common form of conjunctivitis, usually known as pink eye, is coded to H10.01- (Acute follicular conjunctivitis). “To code this properly, you need to state which eye is affected, like the scratched cornea codes. Here, though, you’ll use sixth digits: 1 for the right eye, 2 for the left, and 3 for both. It’s important for your pediatrician to stipulate which eye is involved instead of using the nonspecific code, documented with sixth digit 9,” Holle reminds coders.

Chronic forms of the condition are coded to H10.43- (Chronic follicular conjunctivitis). As with all ICD-10 codes, there are no timeframes designated for acute or chronic conditions, and you will have to rely on your pediatrician’s judgement and documentation to make this determination. Like the acute form of pink eye, you will also need to specify laterality.

Allergic: “This is commonly referred to as red eye because the eye itches and drains. It is treated with topical antihistamines,” explains Holle. Again, depending on your pediatrician’s documentation, this is commonly coded to H10.1- (Acute atopic conjunctivitis), though chronic allergic conjunctivitis can be coded to H10.44 (Vernal conjunctivitis) if the patient is allergic to airborne allergens, or even H10.45 (Other chronic allergic conjunctivitis).

Know When to Use Z01.0-

Fortunately, this last code choice is the easiest.

Your pediatrician will want to perform a vision screening on young patients at various points in their lives as part of their preventive medicine program. The American Academy of Pediatrics (AAP) Bright Futures, for example, recommends a visual acuity screen (the familiar chart with lines of letters in ever-decreasing size) “at ages 4 and 5 years, as well as in cooperative 3-year-olds” (Source: downloads.aap.org/AAP/PDF/periodicity_schedule.pdf).

Remember: Even though a screen is not the same as an exam, which actually diagnoses the patient’s vision condition, you will still simply choose the appropriate code from Z01.0- (Encounter for examination of eyes and vision). The actual code will depend on whether the screen does not reveal an abnormality, in which case you would use Z01.00; or does reveal an abnormality, in which case you would use Z01.01, adding an additional code to specify the abnormality per ICD-10 instructions.