Pediatric Coding Alert

Question: Are there definitions to the 995.5 diagnoses, such as 995.59? Also, what are the medical definitions of 995.50, 995.51, 995.52, 995.53 and 995.54?


Oregon Subscriber
Answer: The ICD-9 manual assigns codes for diagnoses, but it does not provide definitions for diagnoses. In some cases, a publisher may offer guidelines for a diagnosis. But ICD-9 does not issue these "publisher-created" guidelines.

Best bet: The pediatrician must determine whether a specific diagnosis applies. Look up the terms in a medical dictionary or medical literature. When selecting a specific diagnosis, the pediatrician should apply common definitions or "standard" terminology.

For example, medical literature clearly defines pneumonia (such as 486, Pneumonia, organism unspecified). So a physician would not apply that diagnosis for someone with just a cold (460, Acute nasopharyngitis [common cold])

For the 995.5x definitions, you should follow the code titles. Here's how:

When you do not have any specific information - or do not document the child abuse and neglect specifics - select 995.50 (Child abuse, unspecified).
  If you determine a child is suffering from emotional/psychological abuse, use 995.51 (Child emotional/psychological abuse).
  If you decide a child's malnourishment and thinness are due to neglect based on the information you glean from a history and examination, you should report 995.52 (Child neglect [nutritional]).

For clear signs of sexual abuse, bill 995.53 (Child sexual abuse). Use an E code to identify the perpetrator, such as E967.0 (Perpetrator of child and adult abuse; by father, stepfather, or boyfriend).
  If, through investigation, you attribute an injury to physical abuse, report 995.54 (Child physical abuse) and add the specific injury code, such as 821.xx (Fracture of other and unspecified parts of femur ...).
  When 995.50-995.54 do not describe the type of child abuse and neglect that you find, assign 995.59 (Other child abuse and neglect).