Pediatric Coding Alert

Question: Our pediatrician examined a young patient who presented with a sore throat, fever, and a rash on the soles of her feet and the palms of her hands. The doctor arrived at a diagnosis of hand, foot, and mouth disease, which I coded as B08.4. But now I am questioning the use of the code, as the vesicular stomatitis that is mentioned in the code’s descriptor does not appear in the doctor’s notes. So, is B08.4 the correct code to use, or is there another code that more accurately describes the patient’s condition?

Colorado Subscriber

Answer: On the surface, the medical terminology surrounding B08.4 (Enteroviral vesicular stomatitis with exanthem) may seem confusing. Hand, foot, and mouth disease is characterized by both exanthem, which is another term for a widespread rash, and by a sore throat that may or may not materialize into the vesicular stomatitis or herpangina (throat lesions) that the descriptor also mentions.

Fortunately, hand, foot, and mouth disease appears in the ICD-10 index under Disease ⇒ hand, foot, and mouth, leading you to B08.4. And to leave no doubt that B08.4 is the correct code, the tabular entry lists hand, foot, and mouth disease as an alternative name for enteroviral vesicular stomatitis with exanthem.