Pediatric Coding Alert

And add autism screening to your reporting choices.

In the previous issue of Pediatric Coding Alert, we outlined numerous revisions to ICD-10 that will affect pediatric coding after Oct. 1, 2018. They include external cause codes for child abuse and sexual exploitation as well as codes for reporting neonatal withdrawal from therapeutic or addictive drugs.

This month, we examine the addenda to the Z13.- (Encounter for screening for other diseases and disorders) codes that will undoubtedly impact your coding in the months and years to come. Read on for expert advice on how to use them effectively and correctly.

ICD-10 Adds 2 New Mental Health Screens

One addition to the Z13.3- (Encounter for screening examination for mental health and behavioral disorders) subcategory will have an immediate effect on the way you code depression screens. “Currently, screening for depression, etc. is relegated to a not otherwise specified code: Z13.89 [Encounter for screening for other disorder],” explains Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

Now, you’ll have Z13.31 (Encounter for screening for depression), “which means that screening for depression can be specifically reported,” Moore explains. Of special interest to peds coders is its accompanying note, which states it can be used to document a “screening for depression for child or adolescent.”

The other addition, Z13.39 (Encounter for screening examination for other mental health and behavioral disorders), is accompanied by another important note that says the code should be used in “screening for intellectual disabilities.” It’s a significant note for peds coders, as evidence of this disability, according to the American Association on Intellectual and Developmental Disabilities (AAIDD), must occur “during the developmental period, which in the US is operationalized as before the age of 18.”

This will make Z13.39 important in the pediatric setting for establishing that the disability — defined by the AAIDD as “a disability characterized by significant limitations in both intellectual functioning [an IQ measured between 70-75] and in adaptive behavior, which covers many everyday social and practical skills” — was first seen in a patient prior to that patient becoming an adult.

Developmental Screens Overhauled

The 2019 ICD-10 will also include three other screening codes specifically intended for childhood developmental delays:

• Z13.40 — Encounter for screening for unspecified developmental delays
• Z13.42 — Encounter for screening for global developmental delays (milestones)
• Z13.49 — Encounter for screening for other developmental delays.

To use Z13.42, you should note that global developmental delays (GDDs) are defined as delays “in 2 or more developmental domains, including gross or fine motor, speech/language, cognitive, social/personal, and activities of daily living,” according to authors John B. Moeschler and Michael Shevell and the American Academy of Pediatrics (AAP) Committee on Genetics.

More, “the term GDD is reserved for younger children [i.e., typically younger than 5 years], whereas the term ID [intellectual disability] is usually applied to older children for whom IQ testing is valid and reliable,” Moeschler and Shevell point out, suggesting that you should reserve Z13.42 for patients in early childhood (Source: http://pediatrics.aappublications.org/content/134/3/e903).

Guideline alert: You should especially note that the Excludes1 instruction for Z13.4- that prohibits reporting with Z00.1- (Encounter for newborn, infant and child health examinations) has been deleted and replaced with an Excludes2 note that clarifies you can report Z13.4- codes separately from Z00.12- (Encounter for routine child health examination) codes.

New Autism Screen Provides Specificity

ICD-10 has also added a fourth developmental screening code, Z13.41 (Encounter for autism screening), specifically to screen for autism. Like the addition of Z13.31, the introduction of Z13.41 also adds a distinct diagnosis to the screening codes. “It’s a significant addition, as Z13.41 means that screening for autism can now be reported distinct from screening for global developmental delays,” Moore notes.

This will have a clear impact on patient outcomes. “By having these clearly defined diagnoses options instead of ‘unspecified’ diagnoses options, past evaluations and future courses of treatment can be focused rather than needlessly repeated,” according to Barbara Hays, CPC, CPCO, CPMA, CRC, CPC-I, CEMC, CFPC, AAPC Fellow, coding and compliance strategist at the American Academy of Family Physicians. This also allows for “early detection, which is key for treatment and outcome,” Hays says.

But the addition of these more specific codes will also have an impact on your practice’s bottom line. “A more specific diagnosis makes it easier to code and get services paid,” says Hays. “If a payment policy exists with a listing of ICD-10 codes, then it is black and white,” Hays adds.

However, this also means that the service your pediatrician offers cannot go outside of the parameters of the code. “Sometimes, when the listing is too narrow and the diagnoses listed are so specific, or the service provider wants to provide the service ‘off-label,’ that is when it becomes difficult to find any wiggle room to get paid for services,” Hays cautions.