Pediatric Coding Alert

New codes take effect on Oct. 1--Find out if you're ready.

October 1 is just around the corner, and that means you'll soon need to be up and running with the latest ICD-9 changes. Are you wondering where you should focus your time and energy? As we presented in Pediatric Coding Alert Vol. 14, No. 8, pediatric diagnosis code changes aren't abundant this year, but there are still quite a few that could lead you to denied claims if you don't update your forms.

The following quiz on the new, revised, and deleted codes will help you determine whether you're on the right track or if you need to brush up on your ICD-9 coding skills.

Nail Down Flu Codes

Question 1: A 12-year-old patient presents with influenza due to identified novel influenza A virus with pneumonia. Which code should you report?

A. 487.0

B. 488.01

C. 488.81

D. 488.82

Answer: C. Effective Oct. 1, you'll benefit from new code 488.81 (Influenza due to identified novel influenza A virus with pneumonia) to describe this condition. In the past, you most likely would have used 487.0 (Influenza with pneumonia), but that code didn't specify the nature of influenza A.

The ICD-9 Committee has revised the influenza codes several years in a row now, which might make coding these conditions confusing, but the most important fact to keep in mind when reporting these illnesses is to check the documentation for confirmation of the type of influenza that the patient has. When in doubt, check any lab reports or ask the physician to clarify.

Keep in mind: You'll also find revised diagnosis code descriptors for the H1N1 codes, as follows:

• 488.11 -- Influenza due to identified 2009 H1N1 influenza virus with pneumonia
• 488.12 -- Influenza due to identified 2009 H1N1 influenza virus with other respiratory manifestations
• 488.19 -- Influenza due to identified 2009 H1N1 influenza virus with other manifestations

Curb TB Test Confusion

Question 2: A patient presents for a tuberculosis skin test. The results come back showing that the patient experienced a reaction to the test, but does not have active tuberculosis. Which code should you report?

A. 795.51

B. 795.5

C. 795.4

D. 795.52

Answer: A. Effective Oct. 1, the ICD-9 code listing will delete nonspecific code 795.5 (Nonspecific reaction to tuberculin skin test without active tuberculosis) and replace it with two more specific codes, one of which is the accurate answer to this question, 795.51 (Nonspecific reaction to tuberculin skin test without active tuberculosis).

ICD-9 will also introduce code 795.52 (Nonspecific reaction to cell mediated immunity measurement of gamma interferon antigen response without active tuberculosis) to separate out the former 795.5 category.

Ace Anaphylaxis Codes

Question 3. A six-year-old patient presents with a rare anaphylactic reaction due to a vaccination that your pediatrician administered earlier in the day. Which ICD-9 code should you report for the doctor's treatment of anaphylaxis?

A. 999.4

B. 999.5

C. 999.41

D. 999.42

Answer: D. Next year you'll have a wide range of anaphylactic reaction codes, including 999.42 (Anaphylactic reaction due to vaccination), which more specifically describes the situation in our question than the other codes.

Previous codes 999.4 (Anaphylactic shock due to serum) and 999.5 (Other serum reaction) have been deleted for the upcoming round of ICD-9, and several other anaphylaxis codes have been revised, including the following, among others:

• 995.60 -- Anaphylactic reaction due to unspecified food
• 995.61 -- Anaphylactic reaction due to peanuts
• 995.62 -- Anaphylactic reaction due to crustaceans
• 995.63 -- Anaphylactic reaction due to fruits and vegetables
• 995.64 -- Anaphylactic reaction due to tree nuts and seeds

What's the difference? In the past, the codes held similar titles, but the word "shock" in the descriptor was changed to "reaction" to more accurately describe an anaphylactic condition.

Differentiate Migraine Codes

Question 4: A ten-year-old patient presents with a migraine headache with aura, but without status migrainosus. Which code should you report?

A. 346.01

B. 346.11

C. 346.21

D. 346.31

Answer: A. The differences between 346.01 (Migraine with aura, with intractable migraine, so stated, without mention of status migrainosus) and 346.11 (Migraine without aura, with intractable migraine, so stated without mention of status migrainosus) involve whether or not the patient experiences aura. Since the patient in our example had aura, 346.01 is the most accurate code.

Be sure to check the practitioner's documentation for information on whether or not the patient has experienced aura.

To read the entire list of new, deleted, and revised ICD-9 codes, visit the CMS Web site at www.cms.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp.