Pediatric Coding Alert

Update your autumn superbill with an extra digit for dehydration, 'no-vaccination' digit, plus these new diagnoses

This fall's diagnostic changes mean you finally get to specify dehydration, label a child as overweight, and tell why a child didn't receive a vaccine.
 
CMS released the proposed new codes in May 4's Federal Register. "These changes are pretty solid," says Jeffrey Linzer Sr., MD, MICP, FAAP, American Academy of Pediatrics (AAP) representative to the ICD-9-CM editorial advisory board.
 
Here's what you can expect when the new ICD9 Codes become effective Oct. 1, 2005.

Dehydration Will Require a Fifth Digit

 
Get ready to add a fifth digit to the general dehydration diagnosis. Now ICD-9 lumps dehydration, volume depletion and hypovolemia under the same code: 276.5 (Volume depletion).
 
This fall, 276.5 will require a fifth digit to specify whether a child has:
 

276.50 - Volume depletion, unspecified
  

276.51 - Dehydration
  

276.52 - Hypovolemia.

You'll probably only put 276.51 on the superbill. Dehydration and hypovolemia require different treatment approaches. Pediatricians tend to treat dehydration more often than hypovolemia, says Sherry Wilkerson, RHIT, CCS, CCS-P, coding and compliance manager at Catholic Healthcare Audit Network in Clayton, Mo. "But I would certainly ask the pediatricians," if they want the encounter sheet also to include 276.52.

Overweight Diagnosis Becomes an Option

The new codes will allow you to label a patient as overweight without making him obese. "You could use new code 278.02 (Overweight) with V65.3 (Dietary surveillance and counseling) for a child who requires dietary counseling," Linzer says. If the pediatrician does the counseling, you'd assign an E/M code (such as 99212-99215).
 
Don't do this: ICD-9 will introduce numerous body mass index (BMI) codes that will be more specific than the generalized overweight code. But you should not use V85.0-V85.4 with the pediatric population. These codes are for adults only, Linzer says. The AAP is still working to get ICD-9 to introduce a pediatric BMI code.

QT, Hypoxemia May Receive Own Codes

The AAP also encouraged ICD-9 to create a code to recognize Long QT syndrome and hypoxemia. "Long QT is a genetic condition that puts adolescents at risk for cardiac arrest," Linzer says. You will be able to denote the potentially deadly athlete-publicized disease with 426.82 (Long QT syndrome).
 
ICD-9 will also expand the asphyxia subcategory (799.0) to include hypoxemia. You can now differentiate between asphyxia (799.01), hypoxemia (799.02) and hypercapnia (786.09).

Meconium Codes Will Specify Condition

This fall you'll have seven new codes concerning meconium. ICD-9 now groups meconium and aspiration under one classification: 770.1 (Meconium aspiration syndrome).
 
The new codes will add a fifth digit to 770.1 to specify whether the fetus or newborn aspirated other fluids (770.17-770.18) or meconium with respiratory symptoms (770.12) or without respiratory symptoms (770.11), says Pat Wildman, RHIA, CCS-P, clinical reimbursement auditor at Children's Hospital Boston Compliance Department.
 
While the new specificity is a welcome addition, 770.1x will impose one burden. "The physician's documentation in the medical record must be detailed enough to support the appropriate code choice," Wildman says.
 
The new ICD-9 codes will also introduce several related meconium codes. "You'll be able to specify that the meconium was not a significant problem, but you did observe it upon delivery," Linzer says. Possibilities include meconium passage during delivery (763.84) and meconium staining (779.84).

V Codes Explain Why 'No Vaccination'

The ICD-9 update also includes new V codes spelling out the reason a patient didn't receive a vaccination.
 
An insurer or pediatrician will be able to tell whether a vaccination was not carried out "because the child had an acute illness (V64.01) is immune- compromised (V64.03) or the parent refused the service (V64.05)," Linzer says.
 
Bonus: The 10 new codes will allow better immunization tracking to account for missed or delayed vaccinations. In fact, V64.0x could help combat denials or incorrect preventive-medicine benefit allotments for the problematic return-for-vaccine visit. These codes will indicate "why the patient had to come in for a separate visit to receive the immunization," Wilkerson says.