Pediatric Coding Alert

You'll add only the diagnoses you really need and won't unnecessarily cramp your diagnostic encounter sheet if you follow this short action plan that will prepare you for the ICD-9 changes that will take effect Oct. 1.

Look forward to having a code to specifically identify plantar warts (078.12, Plantar wart). "The new diagnosis for plantar's wart is a good one that pediatricians will want to list on their charge ticket," says Donelle Holle, RN, a Ft. Wayne, Ind. pediatric coding and reimbursement national speaker and consultant with more than 30 years of experience, including past director of professional services for the University of Michigan, Dept. of Pediatrics.

Change: You currently have to lump plantar warts under other specified code 078.19 (Other specified viral warts). For destruction of plantar warts, which are benign tumors that occur on the sole, heel or ball of the foot and most often in children and young adults between the ages of 12 and 16, you'll use 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) or 17111 (... 15 or more lesions) with 078.12.

Catch this: If you spot verruca plantaris in chart notes, equate this with plantar warts. The formal Latin term "verruca plantaris," which is an infection caused by human papilloma virus (HPV), will be moved from under 078.19 to under 078.12.

You might also want to add a headache code from the nervous system section to your diagnostic charge ticket. Pediatricians "might also use 339.10 (Tension type headache, not elsewhere classified)," Holle says.

The current system misclassifies tension headache (307.81), which occurs in more than 50 percent of the population, as a psychiatric disorder, according to "Headache Classification 2007" presented by Stephen D. Silberstein, MD, FACP, past president of the American Headache Society, director of the Jefferson Headache Center and neurology professor at Thomas Jefferson University Hospital in Philadelphia (http://www.cdc.gov/nchs/ppt/icd9/att1_headache_mar07.ppt). New code 339.10 will exclude tension headaches due to psychological factors classified under 307.81.

This will give you an ICD-9 code outside the signs and symptoms section (784.0, Headache) that will not trigger a mental health carve out. Because 307.81 is in this section, insurers may not cover the diagnosis due to considering it a mental health benefit that the patient's coverage may not offer.

If your ICD-9 encounter sheet has a V code section for other services, consider including "Family Disruption V61.0X _______". "Pediatricians tend to do a lot of counseling when families are having problems prior to a referral to psychological services," Holle says.

Leave off individually listing the V codes for the family disruptions, Holle recommends. The physician can specify the type on the blank line, and the coder can look up of any of the V61.01 to V61.09 codes, which include disruption due to:

family member on military deployment V61.01

family disruption due to return of family V61.02

member from military deployment

divorce or legal separation V61.03

parent-child estrangement V61.04

child in welfare custody V61.05

child in foster care or in care of V61.06

non-parental family member

other V61.09

You'll have a streamlined way to report methicillin-resistant staphylococcus aureus (MRSA) this fall. Because ICD-9 2008 contains no specific MRSA code, you currently have to use the infectious disease code (041.11, Bacterial infection in conditions classified elsewhere and of unspecified site; staphylococcus aureus) plus V09.0 (Infection with microorganisms resistant to penicillins) to indicate the bacteria are meth-resistant.

Problem: Because the resistance code isn't specific to MR or SA and isn't linked to the SA organism code (041.11), MRSA data collection can be skewed, relayed Rebecca Gomez, MD, MPH, with the Division of Healthcare Quality Promotion Centers for Disease Control and Prevention in her proposal for MRSA specific codes. "National surveys contain a limited number of ICD-9 fields. Organism codes and resistance codes may be deleted."

Simpler method: Starting Oct. 1, you'll be able to report MRSA with either of the following:

ICD-9 2009 will also revise the primary organism codes you currently use for MRSA to indicate methicillin-susceptible S. aureus (MSSA). Code 038.11 will refer to MSSA septicemia; and 041.11 will include MSSA "in conditions classified elsewhere and of unspecified site."

Don't miss: You'll also have two V codes for MRSA. To indicate a patient is a carrier or suspected carrier of MRSA, use V02.53. For personal history of MRSA, report V12.04.