Pediatric Coding Alert

CMS confirms that the implementation date won’t be postponed.

You are already aware of the ICD-10 system that’s planned to take effect on Oct. 1, but many pediatric practices have been holding out on preparing because they believe the date will be postponed. However, that is not likely to happen.

Representatives from the Centers for Medicare and Medicaid Services (CMS) stressed the fact that there won’t be a delay in the ICD-10 compliance date during the agency’s Feb. 20 ICD-10 Readiness Webinar. “The ICD-10 date is firm,” said CMS’s Robert Tagalicod during the presentation. 

“I am pleased to let you know that CMS has been working very closely with numerous stakeholders – medical societies, payers, vendors, and clearinghouses – to ensure a smooth transition to ICD-10,” Tagalicod said. “We recently launched the ICD-10 success initiative as part of a collaboration to share guidance and insights.” 

With that in mind, check out the following three questions and determine whether you know how to report these pediatric diagnoses under ICD-10 so you can be completely ready to submit your claims in October.

Question 1: How will you report uncomplicated mild intermittent asthma under ICD-10?

Answer: When ICD-10 codes go live, the 493 series of ICD-9 codes that you’ve probably memorized will crosswalk to J45 (Asthma). But, unlike ICD-9 codes, your ICD-10 coding is not centered over the etiology of the condition but follows the severity of the symptoms and the necessity for treatment with a nebulizer. This is consistent with the current national asthma treatment guidelines determined by The National Heart, Lung and Blood Institute.

Based on severity, you have the following four states of the condition:

• Mild intermittent
• Mild persistent
• Moderate Persistent
• Severe Persistent

When using ICD-10 codes, you will have to delve into the documentation to assess the severity of the condition as this is necessary for accurate reporting. J45 will further expand to the fourth digit, based on severity, into the following five code sets as described in the guidelines:

• J45.2 (Mild intermittent asthma)
• J45.3 (Mild persistent asthma)
• J45.4 (Moderate persistent asthma)
• J45.5 (Severe persistent asthma)
• J45.9 (Other and unspecified asthma)

All these above mentioned codes further expand to the fifth digit based on the asthma state into uncomplicated, acute exacerbation and status asthmaticus.

For example, J45.2 expands into the following three subsets:

• J45.20 (Mild intermittent asthma, uncomplicated)
• J45.21 (Mild intermittent asthma with (acute) exacerbation)
• J45.22 (Mild intermittent asthma with status asthmaticus)

J45.9 expands into the following code sets:

• J45.90 (Unspecified asthma) that further expands to J45.901, J45.902, J45.909
• J45.99 (Other asthma) that further expands into J45.990 (Exercise-induced bronchospasm); J45.991 (Cough variant asthma) and J45.998 (Other asthma)

The asthma visit can be further coded based on environmental triggers. For instance, tobacco smoke (Z77.22, Contact with and (suspected) exposure to environmental tobacco smoke).

Question 2: How will you code colic under ICD-10?

Answer: If you see a large number of colicky babies, you’ve probably got 789.7 (Colic NOS) burned into your brain, but that will change as of Oct. 1, 2014, when the ICD-10 coding system takes over and 789.7 is wiped away into oblivion. 

When the ICD-10 transition takes place, you’ll still look to a single code to describe patients with colic, and that will be R10.83 (Colic NOS; infantile colic).This is an example of a direct, clear crosswalk from ICD-9 to ICD-10.

You should continue to document colic notes clearly, including information about how long the symptoms have persisted, and the timing of when it happens most often. When the ICD-10 transition gets close, you’ll want to delete 789.7 from your superbills and other internal documents, and replace those instances with code R10.83.

Question 3: You won’t be able to rely on trusty old V20.2 for well child visits effective Oct. 1. Which code will you use for preventive visits like this?

Answer: In 2014, you’ll instead use Z00.129 (Encounter for routine child health examination without abnormal findings) to reflect the physician’s visit. If the physician did encounter abnormal findings during the visit, you’d instead report Z00.121 (Encounter for routine child health examination with abnormal findings).

The key difference between Z00.129 and Z00.121 is whether the visit revealed an abnormal finding during the examination of the patient. The pediatrician must document this. For instance, the physician might examine the patient and note, “patient appears severely speech delayed.”