Sequence These Diagnoses Correctly
Question: Our pediatrician saw a patient who came in after having several days of low-grade fever and runny nose, and then developed a rash on their cheeks. The pediatrician documented a diagnosis of fifth disease and also noted that both of the patient’s ears were infected. The pediatrician prescribed antibiotics for the ear infection but nothing for the fifth disease. Do I code the fifth disease or the bilateral ear infection first, since only the ear infection was treated? Pennsylvania Subscriber Answer: Even though the pediatrician prescribed medication to treat the ear infection, the patient came in for symptoms that manifested due to fifth disease — including the ear infection — and you should code the fifth disease diagnosis first. Look to code B08.3 (Erythema infectiosum [fifth disease]) to report the fifth disease diagnosis. For the bilateral ear infection, look to H67 (Otitis media in diseases classified elsewhere). The ICD-10-CM Tabular List of Diseases and Injuries guidelines for that code have a Code first note instructing you to code the underlying disease first, including viral disease — underscoring the need to report code B08.3 first. Since the infection affects both ears, choose H67.3 (Otitis media in diseases classified elsewhere, bilateral) to report the ear infection. Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC
