Pediatric Coding Alert

Sticking with the current ICD-9 codes you use to describe a colicky newborn who's irritable, not nursing well, and hasn't regained his birth weight will result in three incorrect diagnoses entries and a truncated code denial when new codes go into effect this October.

Check out this primer to prep your encounter sheet for the upcoming changes.

Once insurers start to require ICD-9 2010 diagnoses, expect denials on your newborn follow-up visits if you use feeding difficulties code 779.3 (Feeding problems in newborn).

This code will require a fifth-digit of "1," according to the Centers for Disease Control and Prevention's new diagnosis codes table available from

cms.hhs.gov/ICD9Provider DiagnosticCodes/Downloads/New_Revised_Invalid_Codes_2009.zip.

Example: After a newborn has been discharged from the hospital, "we always do a two- to three-day follow-up visit," notes Charles Scott, MD, FAAP, a pediatrician at Medford Pediatric and Adolescent Medicine in New Jersey. If the infant has nursing issues, you might link this problem-oriented visit to feeding problems:

• currently -- 779.3

• new -- 779.31.

If the newborn hasn't reached his birth weight by one week of age, you might also code failure to thrive. For instance, if a newborn had a birth weight of 6 pounds 3 ounces and at the follow-up newborn visit weighs only 6 pounds, the pediatrician might circle 783.41 for "Failure to thrive."

Problem: Code 783.41 is designated as a pediatric, not newborn code. Subcategory 783.4 specifies for "Lack of expected normal physiological development in childhood."

Remedy: ICD-9 2010 introduces a specific code for failure to thrive in newborn (779.34). Streamline your encounter form by including the newborn code under the childhood code, such as:

• 783.41 -- Failure to thrive

• 779.34 -- Failure to thrive, newborn.

Think 787.07 for vomiting applies across the board? Not so fast.

Code 779.3 (Feeding problems in newborn) lumped regurgitation of food, slow feeding, and vomiting under one code. ICD-9 2010 will expand this subcategory, allowing you to specify bilious vomiting (779.32, Bilious vomiting in newborn) and other vomiting (779.33, Other vomiting in newborn).

On your encounter form, list these conditions under your general heading of "Vomiting" (787.07). Include:

• 787.07 -- Vomiting

• 779.31 -- Vomiting, bilious, newborn

• 779.33 -- Vomiting, other, newborn.

Colic also gets its own code. "The creation of 789.7 (colic) will be useful to the pediatric community as it doesn't lump colic in with generalized abdominal pain," notes Donna Walaszek, CCS-P, medical billing  specialist, at Northampton Area Pediatrics, LLP, in Massachusetts.

You previously had to lump colic under abdominal pain (789.0x), which includes "Colic: NOS and infantile."

A denial would be in store if you forgot to add a fifth digit to represent the location of the pain. Since an infant can't tell you exactly where the pain is localized, you would use 789.07 for "generalized" pain, Walaszek says.

Once you're no longer limited to using 789.07 for colic, expand your "Abdominal Pain" listing to reflect:

• 789.7 -- Abdominal pain, colic

• 789.07 -- Abdominal pain, generalized

• 789.03 -- Abdominal pain, RLQ

• 789.01 -- Abdominal pain, RUQ

• 789.04 -- Abdominal pain, LLQ

• 789.02 -- Abdominal pain, LUQ.

Before jumping at the chance to use two new symptom codes, make sure your pediatrician hasn't established a related definitive diagnosis. "Think of the 797-799 codes as the misfits that didn't fit elsewhere," Walaszek says. When the provider makes a more specific diagnosis, you typically would assign a diagnosis from the appropriate chapter of the ICD-9 book.

Bearing that in mind, you'll soon have an opportunity to better represent irritability and nervousness than with the current code for nervousness (799.2, which will become invalid as of Oct. 1, 2009). New codes in 2010, 799.21 (nervousness), 799.22 (irritability), and 799.23 (impulsiveness) provide a more definitive representation for these presenting signs and symptoms. Two instances when the new symptom codes could apply include:

Example 1: A patient presents with an upset stomach due to nervousness. You should code from chapter 9 for the upset stomach (536.8), Walaszek says. "I believe most would code from chapter 16, nervousness (799.21) as a secondary diagnosis."

Example 2: "As for an irritable baby, not definitively diagnosed with a specific illness, 799.22 (irritability) would certainly be appropriate," Walaszek adds. Another option is fussy infant (780.91).

Let's go back to the original scenario. You would not code for irritability in a newborn diagnosed with colic, as irritability is inherent in the abdominal pain. That means, the three diagnoses would be: