Pediatric Coding Alert

ICD-9 2008 brings changes for 2 herpesvirus infections, recognizes infant botulism

When new ICD-9 codes go into effect this fall, correct coding mandates that you update your superbill with new codes for roseola, Parvovirus and infant botulism.

The Centers for Disease Control & Prevention released the new ICD-9 codes for 2008. They take effect Oct. 1, with no grace period.

Some more codes may be added to the list between now and September, but most of 2008's new additions are already available. Although the 146 new codes for this fall contain relatively few changes for pediatrics, Pediatric Coding Alert zooms in on the roster of disease code changes most important to you.

Default to 058.10 Unless This Occurs

Starting Oct. 1, if you relegate "roseola infantum" to an "other specified" code (057.8, Other specified viral exanthemata), you won't be designating this virus correctly. ICD-9 2008 will debut a new subcategory series (058) for "other human herpesvirus" (HHV).

Eight new codes will identify the herpesvirus based on type and associated clinical condition. You'll use one of three codes (058.10-058.12) for roseola infantum. ICD-9 2008 will let you identify the virus that caused the infection with one of three fifth-digit subclassifications:

• Assign 058.10 "roseola infantum, unspecified" when the medical record doesn't identify the virus type. Expect to default to the unspecified code more often than not. "We will likely use 058.10 if we diagnose roseola, because usually it is a clinical and not a laboratory diagnosis," says Jennifer G. Brinton, MD, FAAP, pediatrician at Utah Valley Pediatrics in Orem. There is no way to tell the viruses apart just from the clinical exam.

• Report 058.11 for "roseola infantum due to human herpesvirus 6." "Primary infection with HHV-6B causes roseola infantum or exanthem subitum, a common childhood exanthema," according to AHIMA's "Summary of March 2006 ICD-9-CM Coordination and Maintenance Committee Meeting."

• Use 058.12 for "roseola infantum due to human herpesvirus 7." "Human herpesvirus 7 (HHV-7) is another beta herpesvirus that causes roseola infantum in infants," state the ICD-9 C&M Committee notes.

Impact: To code for the specific virus, you'd have to have a positive lab result for HHV6 or HHV7--a test your office does not order. Infectious disease (ID) specialists have recommended testing for specific HHV6 or HHV7 only "when we've had an infant with a prolonged fever in whom we could not clinically diagnose roseola," Brinton says.

Thirty percent of children with roseola do not have the classic rash, making clinical diagnosis virtually impossible, according to one ID specialist.

Don't fret about using an unspecified code in these cases. "Unless you are billing a procedure on a specific body area that requires a specific matching diagnosis," the ICD-9 code shouldn't affect payment, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

Include Kaposi's in Other HHV Code
 
The 058 subcategory will also put an end to lumping HHV-8 and Kaposi's under 057.8. You'll instead report the infections with 058.89 (Other human herpesvirus infection; other), which will also include:

• human herpesvirus 8 (HHV-8) infection

- Kaposi's sarcoma-associated herpesvirus infection.

The new subcategory lists a number o exclusions, which ICD-9 classifies to other areas. For instance per ICD-9's "excludes: note, you should not use 058.xx for the following infections:

-- Epstein-Barr virus (075)

-- herpes simplex (054.0-054.9)

-- varicella-zoster virus (052.0-053.9).

Another virus that comes into its own in ICD-9 2008 is the parvovirus.  Code 079.83 fills in the gap for "Parvovirus B19."

Anticipate Infant-Specific Botulism Code

ICD-9 2008 will also offer you more specificity for claims involving botulism. Two new codes will capture botulism not associated with food poisoning. "Botulism, neuromuscular poisoning from Clostridium botulinum toxin, occurs in three forms: food-borne, wound, and infant botulism," according to AHIMA's ICD-9 summary.

A current hunt for "botulism" produces a code for only food-borne botulism, 005.1. You report wound botulism with the site-specific open wound code, such as 881.10 (Complicated open wound of forearm). When  ICD-9 2008 goes into effect this fall, get specific with:

• 040.41 for "Infant botulism," which occurs most often in infants younger than 6 months who've ingested C. botulinum spores.

• 040.42 for "Wound botulism," which results from traumatic injury or a deep puncture wound.
 
Code 005.1 (Botulism) will refer to "Botulism food poisoning" in the ICD-9 2008 manual to align with the additions of 040.41 and 040.42.