Pediatric Coding Alert

Test yourself with this quick quiz.

ICD-10’s implementation is less than a year away, and you’ll be expected to know how to code all of your diagnoses on Oct. 1, 2015, since there is no “ramp up” period. Determine whether you can choose the right diagnosis code for these common pediatric conditions.

Question 1. You see a patient with acute bronchitis due to streptococcus. Which ICD-10 code will you report?

Question 2. While playing in the park, a five-year-old child was bitten by a dog. The patient presents to the pediatrician with an open wound of the right hand and lip. The physician cleaned and sutured the wounds. 

Question 3. A patient presents with pneumonia and accompanying diarrhea. The doctor has not identified the virus causing the pneumonia.

Check Your Answers

If you’ve finished the quiz and written down your answers, read on to see how you fared.

Answer 1: You should report J20.2 (Acute bronchitis due to streptococcus) for this diagnosis under ICD-10. However, if the specific cause is not determined at the time of the visit, the unspecified bronchitis code is appropriate (J20.9).

You’ll face big changes in reporting acute bronchitis when ICD-10 goes into effect in 2014, including needing to focus more on what causes the condition. 

Currently, ICD-9 lists only a single code for acute bronchitis: 466.0. You report 466.0 for any case of acute bronchitis with no concern for etiology, unless the patient has acute bronchitis with chronic obstructive pulmonary disease, in which case you report 491.22. 

ICD-10 expansion: When ICD-9 shifts to ICD-10, you’ll begin your code search with J20.- (Acute bronchitis). Then you’ll drill down to a more specific code that describes the etiology. Your ten new choices will be: 

J20.0 (Acute bronchitis due to Mycoplasma pneumoniae)
J20.1 (Acute bronchitis due to Hemophilus influenzae)
J20.2 (Acute bronchitis due to streptococcus)
J20.3 (Acute bronchitis due to coxsackie virus)
J20.4 (Acute bronchitis due to parainfluenza virus)
J20.5 (Acute bronchitis due to respiratory syncytial virus)
J20.6 (Acute bronchitis due to rhinovirus)
J20.7 (Acute bronchitis due to echovirus)
J20.8 (Acute bronchitis due to other specified organisms)
J20.9 (Acute bronchitis, unspecified)

Note: Code family J20.x will cover all cases of acute and subacute bronchitis along with acute tracheobronchitis. However, J20.x will not include allergic bronchitis (J45.909, Unspecified asthma, uncomplicated) and all types of chronic bronchitis (J42, Unspecified chronic bronchitis; J41.0, Simple chronic bronchitis; J44.0, Chronic obstructive pulmonary disease with acute lower respiratory infection; J41.1, Mucopurulent chronic bronchitis). 

Age watch: Pay attention when your pediatrician diagnoses bronchitis NOS (not otherwise specified). You’ll still turn to J20.9 for patients below the age of 15. If the patient is above age 15, you’ll report bronchitis NOS with J40 (Bronchitis, not specified as acute or chronic) instead.

Answer 2: The following ICD-10-CM codes would be assigned to this multiple-diagnosis situation:

S01.501A: Unspecified open wound of lip, initial encounter
S61.401A: Unspecified open wound of right hand, initial encounter
W54.0xxA: Bitten by dog, initial encounter
Y92.830:  Public park as the place of occurrence of the external cause

The “W” and “Y” codes shown here (as well as “V” and “X” codes, which are also new under ICD-10) in this situation are similar to what the “E” codes are under ICD-9, in that they give additional details to your main codes (which are the “S” codes). 

Answer 3. In this case, you’ll report J11.2 (Influenza due to unidentified influenza virus with gastrointestinal manifestations). In addition, you’ll report the code for the diarrhea (R19.7, Diarrhea, unspecified) as well.

Here’s why: When ICD-10 comes into effect, the current pneumonia series 487 will crosswalk to J10 (Influenza due to other identified influenza virus) and J11 (Influenza due to unidentified influenza virus). As with ICD-9, both J10 and J11 further expand into a fourth digit classification based on the presence or absence of pneumonia, other respiratory manifestations (such as laryngitis, pharyngitis, and upper respiratory infections), gastrointestinal manifestations, or other manifestations such as encephalopathy, myocarditis, or otitis media.

You’ll identify other manifestations such as encephalopathy, otitis media or myocarditis, with a fifth digit. Like the 487 series in ICD-9, J10 and J11 include seasonal influenza viruses.

For example, J10 under ICD-10 expands into the following four codes using a fourth digit expansion:

J10.0 (Influenza due to other identified influenza virus with pneumonia)
J10.1 (Influenza due to other identified influenza virus with other respiratory manifestations)
J10.2 (Influenza due to other identified influenza virus with gastrointestinal manifestations)
J10.8 (Influenza due to other identified influenza virus with other manifestations)

J10.0 further expands into the following three codes using a 5th digit expansion based on the type of pneumonia involved:

J10.00 (Influenza due to other identified influenza virus with unspecified type of pneumonia)
J10.01 (Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia)
J10.08 (Influenza due to other identified influenza virus with other specified pneumonia) (Code also other specified type of pneumonia)

J10.8 further expands into the following four codes using a 5th digit expansion based on the type of manifestation:

J10.81 (Influenza due to other identified influenza virus with encephalopathy)
J10.82 (Influenza due to other identified influenza virus with myocarditis)
J10.83 (Influenza due to other identified influenza virus with otitis media)
J10.89 (Influenza due to other identified influenza virus with other manifestations). Use additional code to identify the manifestation.

Red flag: Do not use the J10 series unless the physician has definitively identified the type of influenza virus. If it is not identified, use the J11 series.