Pediatric Coding Alert

Question: We recently had a patient who has had recurrent ear problems. The family is going on vacation across country and wanted to have the childs ears checked first. The child is well but had an upper respiratory infection (URI) several weeks ago, which is the cause of the mothers concern. Which diagnosis code should we use for this visit?

Connecticut Subscriber

Answer: This is a common coding dilemma in pediatrics. Because no rule-out codes exist, you should use V65.5 (Person with feared complaint in whom no diagnosis was made), also known as the "worried well" code, in the secondary position. Use the diagnosis code for otitis media (381.xx, 382.xx) as the primary diagnosis. This code combination tells the payer that you were concerned about possible otitis media but that the patient did not have it.

You should try, however, to obtain some clear reason for the mothers concern that you can use as a symptom diagnosis. For example, if the child was complaining of ear pain, use otalgia (388.70). If the parent is concerned because of recurrent history of URI, you occasionally could report 465.9 (Acute upper respiratory infections of multiple or unspecified sites).