Pediatric Coding Alert

Injury code hinges on your venomous, nonvenomous savvy -- and more.

Think a tick is venomous? That error will land you with the wrong ICD-9 code(s).

Tick season is approaching once again. Get the scoop you need to land all possible diagnoses for a tick removal or tick bite codes with this guide.

Go With 910-919 for Nonvenomous Bite

To support a tick bite or tick removal E/M or foreign body removal (FBR), the first diagnosis code you'll need is the injury code. What caused the injury that requires care? A bite.

In the ICD-9-CM index, if you look up "bite: insect," you're faced with a dilemma. Is a tick venomous or nonvenomous? Ticks can infect a child, but they don't have venom like an ant mite would.

That specific information lets you choose "bite: insect, nonvenomous," which directs you to the site-specific superficial injury codes (910-919). If you had incorrectly classified a tick as venomous, you would have ended up with a nonspecific diagnosis of 989.5 (Toxic effect of other substances, chiefly nonmedicinal as to source; venom).

Show Removal, Bite With 2 Injury Codes

Choose 910-919's third digit based on the bite's location.

For instance, a bite on the forearm goes to 913.4 or 913.5 (Superficial injury of elbow, forearm, and wrist ...) dependent on whether it is infected (5) or not (4).

One detail tells you whether you should call on one or two 910-919 codes. Ask, "Does the encounter involve tick removal?"

If the answer is "Yes", you should use two injury diagnoses. For simple tick removal, go with 910-919 with .6 for superficial foreign body and .4 for a noninfected insect bite.

For a bite with no tick, drop the foreign body code (91x.6).

Indicate Lyme Concern Using This Tool

Because Lyme disease or symptoms of it don't usually show up until seven to 10 days after the bite, many practices don't routinely screen at the initial tick bite or tick removal encounter for the disease. How do you prepare the insurer in the event the patient does contract Lyme disease?

Action: If there is a concern about Lyme exposure, then use the appropriate V code to indicate exposure. Report Lyme exposure with V01.89 (Contact with or exposure to other communicable diseases).

Show Invertebrate Caused Bite with E Code For an insurer that accepts E codes, you may also assign an E code to explain the injury's cause. For easy coding of your external causes, in ICD-9-CM volume 2 section 3 you can find the Alphabetic Index to External Causes of Injury and Poisoning.

If you look up "Bite: insect (nonvenomous)," the index refers you to E906.4. To indicate that a nonvenomous arthropod (an invertebrate such as an insect lacking a backbone) caused the injury, you could add E906.4 (Other injury caused by animals; bite of nonvenomous arthropod).

E codes are not currently required by payers, but do provide a more complete picture of an injury, poisoning, or adverse event.

Put Diagnoses Together

Not sure how all these diagnoses line up? Sequence this example:

A mom brings in her 4-year-old daughter who has refused to let the mother remove a tick from her child's calf. The pediatrician evaluates the spot, asks questions about Lyme disease-related symptoms, removes the tick using probing tweezers, and decides to hold off on antibiotic treatment since the patient has no signs of Lyme disease.

The claim might be coded with 916.4 (... insect bite, nonvenomous, without mention of infection) for the bite and E906.4 (optional) to indicate an injury from a nonvenomous arthropod.

If the patient later returned and the pediatrician diagnosed the patient with Lyme disease from an infected tick bite, you would report only the disease (088.81, Lyme disease). It's typically a given that it came from a tick.

To code for the CPT service, you'd report the appropriate E/M code, such as 99211-99215 or 10120 for removal requiring opening the skin to remove a foreign body, depending on the documentation.