Pediatric Coding Alert

Plus: ICD-10 will not be further delayed—expect Oct. 1 implementation.

Let’s face it: You’re so accustomed to reporting 784.7 for your nosebleed visits that you memorized it years ago. But when ICD-10 takes effect in a few short months, you’ll have to shift your coding to adjust for a few new options. Check out this pediatric case study and determine how you’d code the scenario—then check to see if you applied the correct diagnosis codes.

Scenario: A four-year-old patient presents with a nosebleed that started before bed last night. The parents got the bleeding to stop using compression, but it started up again this morning when she woke up and hasn’t stopped for over an hour. The patient does not have a history of nosebleeds and denies picking at her nose or putting anything into it.

When the pediatrician examines the patient, he finds that she has a small bead stuck in her left nostril, which he extracts using forceps. He then packs the nostril with gauze until the bleeding stops. 

Which codes would you choose? In addition to an appropriate E/M code, you’ll also report the nosebleed control since the physician used packing to stop the bleeding. Therefore, your procedure codes will likely be 99213-25 (Outpatient office visit; Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service), 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method) and 30300 (Removal foreign body, intranasal; office type procedure). Many payers also request that you append the LT (Left side) modifier to 30300 to indicate the anatomic location of the bead that the pediatrician discovered.

As for your ICD-10 codes, you’ll link R04.0 (Epistaxis) to 30901 and 99213, and you’ll report T17.1XXA (Foreign body in nostril, initial encounter) with 30300 and 99213. 

No ICD-10 Delay

In addition, if you were hoping for an ICD-10 delay like last year, then prepare for disappointment. Congress repealed the Medicare Sustainable Growth Rate (SGR) formula without any mention of an ICD-10 delay, thus ensuring the ICD-10 implementation date momentum. 

“ICD-10 needs to happen, and I’m glad to know there is no further delay,” says Suzan Hauptman, MPM, CPC, CEMC, CEDC, director of coding operations at Allegheny Health Network in Pittsburgh, Pa. “Millions of dollars have been spent in testing, educating, and implementation planning. We are ready. And if we aren’t ready, we need to get ready — and fast!”

Unlike last year, when House leadership slid a last minute rider into the SGR legislation (the third postponement in six years), you have no more leeway when it comes to getting your practice ready for ICD-10.

You may know that ICD-10 is the mandated replacement of ICD-9 code sets that you’ve been using right now to report diagnoses and procedures, but if you’re afraid to make the shift, then take heart. “No one was born knowing ICD-9 yet we all know it,” Hauptman says. “ICD-10 is different, but we’ll learn it and we’ll thrive in it. It makes sense. It helps coders by having the physician document in further detail. It helps insurance companies to understand the truer picture of the patient. It certainly will help with outcomes as staff will understand the condition of the patient. And certainly the bottom line reimbursement will be more substantiated with the more detailed documentation. We need this, and I’m glad to see it’s moving forward.”