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Pediatric Coding Alert

ICD-9 Codes for 2003:

New Diagnosis for Fussy Baby Tops List of Extensive Changes

Published on Sun Sep 01, 2002

Pediatricians will welcome the new and revised ICD9 codes for 2003, which add specificity and provide solutions for many previously overlooked pediatric diagnoses.

The new codes go into effect on Oct. 1, 2002. Many payers may not have the new codes entered in their systems until they become mandatory on Jan. 1, 2003, so check with your carriers before filing claims with the new diagnoses.

Many codes reflect a trend toward greater specificity. Codes 770.8, 771.8, 779.8 and 780.9 now require a fifth digit, as detailed below.

Fussy Baby,Crying Codes Allow Accurate Reporting

Most important, pediatricians now have a specific diagnosis for fussy infant. Coders previously recommended 789.00 (Abdominal pain, unspecified site) for abdominal pain because a fussy baby usually has colic (Pediatric Coding Alert, April 2003, page 27.) Pediatricians can now access 780.91 (Fussy infant [baby]).

In addition, pediatricians can report visits for excessive crying of an infant with new code 780.92 (Excessive crying of infant [baby]).

ICD-9 2003 removes the four-digit reporting of 780.9 (Other general symptoms) and requires a fifth digit of 9 to report other general symptoms.

Respiratory Codes Offer Greater Specificity

CMS creates a fifth digit for 770.8 (Other respiratory problems after birth). Apnea, cyanotic attacks and respiratory failures are now individually defined rather than grouped into one code. The new diagnoses include:

  • 770.81 Primary apnea of newborn
  • 770.82 Other apnea of newborn
  • 770.83 Cyanotic attacks of newborn
  • 770.84 Respiratory failure of newborn.

    Code 770.8 is renumbered as 770.89 (Other respiratory problems after birth).

    Infections Are Further Defined

    Similarly, 771.8 now requires a fifth digit, which describes specific, newborn infections rather than encompassing sepsis, urinary tract infections (UTI) and bacteremia into one code. Code 771.8 (Other infection specific to the perinatal period) is now 771.89. Individual diagnoses are now defined as:

  • Sepsis 771.81 (Septicemia [sepsis] of newborn)
  • UTI 771.82 (Urinary tract infection of newborn)
  • Bacteremia 771.83 (Bacteremia of newborn).

    Neonatal Bradycardia,Tachycardia Dxs Are Created

    The ICD-9 tabular list previously instructed coders to use 763.83 (Abnormality in fetal heart rate or rhythm, unspecified as to time of onset) for bradycardia, newborn. ICD-9 2002 allow pediatricians to assign specific neonatal diagnosis for:

  • Bradycardia 779.81 (Neonatal bradycardia)
  • Tachycardia 779.82 (Neonatal tachycardia).

    Codes 779.81 and 779.82 appear under "other specified conditions originating in the perinatal period." For 2002, this definition correlated to 779.8. This code is now 779.89.

    Short Gestation Codes Are Expanded

    The 765 series (Disorders relating to short gestation and unspecified low birthweight) adds a new category 765.2x (Weeks of gestation). The fifth digit describes the amount of completed weeks of gestation from unspecified to 37 completed weeks of gestation, broken down as follows:

  • 765.20 Unspecified weeks of gestation
  • 765.21 Less than 24 completed weeks of gestation
  • 765.22 24 completed weeks of gestation
  • 765.23 25-26 completed weeks of gestation
  • 765.24 27-28 completed weeks of gestation
  • 765.25 29-30 completed weeks of gestation
  • 765.26 31-32 completed weeks of gestation
  • 765.27 33-34 completed weeks of gestation
  • 765.28 35-36 completed weeks of gestation
  • 765.29 37 or more completed weeks of gestation.

    Two New Disease Codes Are Added

    ICD-9 2003 contains two new infectious and parasitic disease codes. West Nile fever was previously contained under the catchall heading of other mosquito-borne fever (066.3). The disease is now reported 066.4 (West Nile fever).

    In addition, a specific code appears for toxic shock syndrome. The ICD-9 tabular list for 2002 assigns 040.89 (Other specified bacterial diseases, other) for the bacterial disease. For 2003, coders should use new fifth-digit code 040.82 (Toxic shock syndrome) for toxic shock.

    Anthrax Codes Emerge

    In the wake of Sept. 11, CMS establishes several diagnoses for anthrax findings, exposure and evaluation, including two diagnoses codes:

  • 795.31 Nonspecific positive findings for anthrax
  • 795.39 Other nonspecific positive culture findings.

    And four V codes:

  • V01.81 Contact with or exposure to communicable diseases, anthrax
  • V01.89 Contact with or exposure to communicable diseases, other communicable diseases
  • V71.82 Observation and evaluation for suspected exposure to anthrax
  • V71.83 Observation and evaluation for suspected exposure to other biological agent.

    E Codes Reflect Terrorism,Sports Injuries

    CMS expands the section on external causes with four codes for injuries from new sports. The E885 series (Fall on same level from slipping, tripping, or stumbling) contains one new code for falls from a scooter (E885.0, Fall from [nonmotorized] scooter). Three new codes describe injuries from paintball guns, including:

  • Accidental E922.5 (Accidental injury caused by paintball gun)
  • Self-inflicted E955.7 (Suicide/self-inflicted injury caused by paintball gun)
  • Undetermined E985.7 (Injury caused by paintball gun, undetermined whether accidentally or purposely inflicted).

    In addition, a new E series reflects the increased threat of terrorism. The legal intervention series (E970-E978) contains E979x (Terrorism involving ...), which includes:

  • E979.0 explosion of marine weapons
  • E979.1 destruction of aircraft
  • E979.2 other explosions and fragments
  • E979.3 fires, conflagration and hot substances
  • E979.4 firearms
  • E979.5 nuclear weapons
  • E979.6 biological weapons
  • E979.7 chemical weapons
  • E979.8 other means
  • E979.9 Terrorism, secondary effects.

    The E999 (Late effect of injury due to war operations) series adds a fourth, required digit and a code for terrorism. The 2002 ICD-9 code E999 is now E999.0. Code E999.1 describes "late effect of injury due to terrorism."

    For a complete list of ICD-9 changes and revisions, visit www.access.gpo.gov/su_docs/aces/aces140.html and enter "page 31627" in the search terms box. Select "fr09my02P [[pp. 31603-31652]] Medicare Program; Changes to the Hospital Inpatient Prospective" in html, pdf or summary format.

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