Pediatric Coding Alert

Question: What diagnosis code is appropriate to use when checking a child after a motor vehicle accident in which no trauma is found?

Lisa Proffitt, Billing Manager
Family Care Center, Jacksonville, FL

Answer: Its always best to code for signs and symptoms, if there are any, says Angie Walker, practice manager for West Georgia Pediatrics, a three-pediatrician, one-nurse practitioner practice in Carrollton, GA. Either go by what the child is complaining of, or what the parents are complaining of, she says. For example, if the child says his head is hurting, use 784.0 (headache). And, in the case of an infant, if the mother thinks the baby hit his head and it hurts, use 784.0. Rely on the Symptoms, Signs, and Ill-Defined Conditions section of the ICD-9 bookand not on the E codes, which may seem more specific to an accident, but which can never be used as the primary diagnosis. They are just used in support of the primary diagnosis, to explain how and where an injury occurred. The beauty of the signs and symptoms codes is that you can use them regardless of whether there are any positive findings in the examination. The E codes, which may seem more specifically descriptive of an accident, are not as useful. For example, accidental falls (E880-E888) would be used for seeing a child after a fall, whether trauma were found or not. But many of these codes can not be used as a primary diagnosis. For fall from playground equipment, you would use E884.0. But you would also have to use a sign and symptom code. Obviously, if trauma were found, you would use that as the primary diagnosis code.

Here is the order of preference for diagnosis codes in this and similar cases: (1) injury (if present), (2) sign or symptom, and (3) observation following an accident (V71.4), explains Thomas Kent, CMM, former office manager of a pediatric practice and principal of Kent Medical Management in Dunkirk, MD. You dont need the V71.4 code if there is an injury. The V71.4 code can be listed first if neither of the other options is present (the child has no damage and no complaints.) The V71.4 would be listed second if a sign or symptom is present. If injuries are present, list the injury code first and support it with E codes (the V code is no longer necessary).