Pediatric Coding Alert

Your 780.6 entry will soon require four more linesTo report a fever of unknown origin (FUO), you'll need one more code in your arsenal this fall.If you don't have a fifth digit on 780.6 (Fever), you can expect a denial starting Oct. 1. The ICD-9 2009 Coordination and Maintenance Committee plans to expand the code to include six new codes. Here's how you'll use them.Update Fever NOS, UO to Include '0' EndingFor FUO, you'll look to 780.60 (Fever, unspecified). This code will also include:• chills with fever• fever not otherwise specified (NOS)• fever of unknown origin • hyperpyrexia NOS• pyrexia NOS• pyrexia of unknown origin.Identify Condition, Associated Fever With 2 CodesWhen the patient's fever is associated with a condition, you'll switch to 780.61 (Fever presenting with conditions classified elsewhere). You now lump this type of fever under the general fever code 780.6, which ICD-9 2009 will revise to read, "Fever and other physiologic disturbances of temperature regulation."Be careful: Code 780.61 is an underlying-condition code. You would first list any underlying contributing condition, says Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine, department of pediatrics at Children's Healthcare of Atlanta at Egleston.For example, you would code a child with acute lymphoid leukemia (ALL) and fever as 204.00 for the ALL and 780.61 for the fever presenting with conditions classified elsewhere, Linzer says. Look to 780.63 for Fever From ImmunizationYou'll have two codes for fevers that develop after a procedure or service. For a postprocedural fever, use 780.62 (Postprocedural fever). If after receiving a vaccine, a child runs a fever that requires treatment, you'll have 780.63 (Postvaccination fever.)Consider 2 Really Cold CodesLook forward to two additional codes for chills without fever and hypothermia, which the ICD-9 American Academy of Pediatrics (AAP) representative requested. You'll classify chills without fever and chills NOS to 780.64 (Chills without fever). For hypothermia, you may use 780.65 (Hypothermia).Pay attention: These codes exclude chills and hypothermia associated with a confirmed infection. If the patient has these symptoms due to a diagnosed infection, you would instead code the infection.Squeeze 4 Codes Onto Your SuperbillYou're going to have to make room for these key fever ICD-9 codes on your diagnoses encounter sheets. "Put the specific codes on the encounter forms," says Victoria S. Jackson, practice management consultant with JCM Inc. in California. Otherwise, physicians might not remember to chart the specific one.On an encounter form, Jackson suggests, make sure to include the following: • 780.60 (Fever, unspecified)
• 780.61 (Fever presenting with conditions classified elsewhere)
• 780.62 (Postprocedural fever)
• 780.63 (Postvaccination fever).
Pediatric practices would probably not use the other ones very often, Jackson says.