Pediatric Coding Alert

Question: A father came to us asking for blood work to be done on a child that was exposed to drugs at his mother’s house. The father did not say what drugs they were. What ICD-10 code can I use in this situation?

AAPC Forum Participant

Answer: The problem in assigning a code in this encounter lies in the vagueness of the situation. In addition to not knowing the kind of drug the child was exposed to, you do not know whether the child inhaled or ingested a drug or whether the child experienced a toxic or adverse effect from the experience. Without the child experiencing any adverse signs or symptoms from the encounter, most payers will question the medical necessity of testing.

However, you might try Z77.29 (Contact with and (suspected) exposure to other hazardous substances) or even Z04.89 (Encounter for examination and observation for other specified reasons). You might also add a code from Z63 (Other problems related to primary support group, including family circumstances) to emphasize problems with the child’s living situation. But in the end, none of these are really symptoms, so they don’t really support medical necessity. In this situation, you may have to explain to the father up front that he may have to foot the bill for the test.