Pediatric Coding Alert

Plus: HHS confirms that ICD-10 date will be pushed back.

Although nosebleeds can be common in childhood, sometimes parents are unable to stop the flow of blood and bring their children in for a visit to determine how to stop the bleeding. In other cases, you might see a child who isn't currently experiencing a nosebleed, but has them so frequently that the parent wants to know if something more complex is going on that causes the nosebleeds.

Under ICD-9 rules, you have just one code to report for nosebleeds, which is 784.7 (Epistaxis). This code describes all nosebleeds that aren't caused by a more complex condition.

ICD-10 Changes: When the ICD-10 transition takes place, you'll benefit from a one-to-one crosswalk. Code R04.0 will be your new go-to diagnosis code when reporting nosebleeds.

Documentation: You should continue to document nosebleed cases as you have been, using information such as the timing, duration, severity, context, modifying factors, and other pertinent information to ensure that the note is complete.

Keep in mind that some insurers want to see which nostril was bleeding via modifiers such as RT (Right side), LT (Left side), or 50 (Bilateral). Therefore, the documentation should very clearly include this information. In addition, if another cause is discovered for the bloody nose (such as a nasal fracture), you would report the fracture diagnosis code and not the epistaxis.

Coder Tips: When the ICD-10 transition gets close, be sure to replace 784.7 on your superbills and replace that code with R04.0.

In other ICD-10 news: The Dept. of Health and Human Services (HHS) announced on Feb. 16 that the ICD-10 implementation date will be postponed. The agency stated that it "will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10^th Edition diagnosis and procedure codes (ICD-10)."

"ICD-10 codes are important to many positive improvements in our health care system," said HHS Secretary Kathleen Sebelius in a statement. "We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead," Sebelius said. "We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system."

It is currently unclear what the new timeline will be, and how far past the previous deadline of Oct. 1, 2013 it will be pushed. Keep an eye on Pediatric Coding Alert for more on this story as it progresses.