Primary Care Coding Alert

To report a fever of unknown origin (FUO), you-ll need one more code in your arsenal this fall.

If you don't have a fifth-digit on 780.6 (Fever), you can expect a denial starting Oct. 1. The ICD-9 2009 Coordination and Maintenance Committee plans on expanding the code to include five new codes. Here's how you-ll use them.

For FUO, you-ll look to 780.60 (Fever, unspecified). This code will also include:

- chills with fever

- fever NOS

- fever of unknown origin

- hyperpyrexia NOS

- pyrexia NOS

- pyrexia of unknown origin.

When the patient's fever is associated with a condition, you-ll switch to 780.61 (Fever presenting with conditions classified elsewhere). You currently lump this type of fever under the general fever code 780.6, which ICD-9 2009 will revise to read, "Fever and other physiologic disturbances of temperature regulation."

Be careful: You should use 780.61 as an underlying condition code.

You would first list any underlying contributing condition, says Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine Department of Pediatrics at Children's Healthcare of Atlanta at Egleston.

For example, you would code a child with acute lymphoid leukemia (ALL) and fever as 204.00 (Lymphoid leukemia; acute; without mention of remission) for the ALL and 780.61 for the fever presenting with conditions classified elsewhere, Linzer explains.

You-ll have two codes for fevers that develop after a procedure or service.

For a postprocedural fever, use 780.62 (- postprocedural fever). If, after receiving a vaccine, a child runs a fever that requires treatment, you-ll have 780.63 (- postvaccination fever.)

You-re going to have to make room for these key fever ICD-9 codes on your diagnoses encounter sheets. "Put the specific codes on the encounter forms," recommends Victoria S. Jackson, practice management consultant with JCM Inc. in California. Otherwise, physicians might not remember to chart the specific one.

On an encounter form, Jackson suggests recording:

- 780.60 (Fever, unspecified)
- 780.61 (Fever presenting with conditions classified elsewhere)
- 780.62 (Postprocedural fever)
- 780.63 (Postvaccination fever).