Pediatric Coding Alert

Question: Our pediatrician recently diagnosed a 10-day old patient with bacterial conjunctivitis caused by the gonococcus bacterium. I know it’s bacterial, but there isn’t additional information, so how do I know which one of the H10.- (Conjunctivitis) codes to report?

Delaware Subscriber

Answer: Conjunctivitis can get tricky, but this bacterium as well as the patient’s age make this case even trickier. That’s because a gonococcus bacterial infection in the eye typically originated from a sexually transmitted gonorrhea infection. Babies pick up the bacteria during vaginal delivery from a mother’s genital tract, which leads to the infection. Older patients contract the condition by using towels, cosmetics, or by touching their eyes with a hand that’s been in contact with the bacteria.

While the H10.- codes do describe many forms of bacterial conjunctivitis, the code for the type of conjunctivitis described above is housed in Chapter 1: Certain Infectious and Parasitic Disease (A00-B99) rather than Chapter 7: Diseases of the Eye and Adnexa (H00-H59). Furthermore, the code for gonococcal conjunctivitis is different when the patient is a neonate (younger than 28 days old). Because the patient is 10 days old, the code you should report is P39.1 (Neonatal conjunctivitis and dacryocystitis).

Note the inclusion terms for P39.1, which are chlamydial conjunctivitis and ophthalmia neonatorum NOS. Pay attention also to the Excludes1 note which instructs you to code to A54.31 (Gonococcal conjunctivitis) when reporting the condition in a patient older than 28 days.