Primary Care Coding Alert

Come Oct. 1, your newborn problem ICD-9 coding will be more specific thanks to age-specific additions for feeding problems as well as codes for vomiting and failure to thrive.

ICD-9 2010 brings an expanded 779.3x (Feeding problems in newborn).

• 779.31 (Feeding problems in newborn): Feeding problems can be broadly categorized as underfeeding and overfeeding. Underfeeding results from the infant's failure to take sufficient amounts of milk. Oftentimes, family physicians spot this problem when there is a failure to gain weight appropriate for their age or when the mother notices that their infant suckles infrequently or for only short periods of time. Overfeeding results from supplemental foods and therefore is not a problem in the perinatal period.

• 779.32 (Bilious vomiting in newborn): Bilious vomiting is vomiting of gastric contents containing bile, often described as greenish vomitus.

• 779.33 (Other vomiting in newborn): Vomiting is the complete emptying of the stomach contents often occurring after feeding.

• 779.34 (Failure to thrive in newborn): This occurs when an infant's physical growth as measured by his weight and height is significantly below the average for his age group.

Most of these conditions were previously lumped under 779.3. These changes make the coder's job much easier. "The more specific the codes, the better for all," says Gwenn S. O'Keeffe, MD, CEO and founder of

Pediatrics Now LLC in Massachusetts. "We can be more specific with what the child actually has, which benefits the family, the medical record, and our ability to be paid fairly and correctly."

Incorporating these new codes into your practice will be a breeze with four easy tips:

1: Use 779.31, 779.34 for Follow-Up Visit Problems

Remember that follow-up visits after a hospital discharge are not necessarily well visits. After a newborn has been discharged from the hospital, "we always do a two- to three-day follow-up visit," notes Charles Scott, MD, FAAP, a pediatrician at Medford Pediatric and Adolescent Medicine in New Jersey.

Family physicians make use of this visit to evaluate the presence of any problems a newborn may have, and commonly, this will include feeding problems. For example, during a visit, the mother relays to the FP that her infant seems to have difficulty latching onto her nipple. Code 779.31. Likely in this case, the FP will spot low birth weight gains. Therefore, also code 779.34.

Regurgitation means retuning small amounts of swallowed milk shortly after or while feeding. Compare this to vomiting, which is the complete emptying of stomach contents. Although regurgitation is a natural occurrence during the first months of life, it often makes new parents worry.

Example: During an office visit, a mother tells the FP that she is worried when she notices small amounts of milk coming from her infant's mouth after feeding. There is no specific code for regurgitation in the ICD-9-CM.

In the ICD-9-CM 2009 index to diseases, the listing for "regurgitation" leads to the code for vomiting alone (787.03). Using the new 2010 codes, here are three possible scenarios:

1.If the FP documents the mother's observation as newborn vomiting, consider coding it as 779.33 in 2010.

2.Use 779.31 if documentation indicates it's a feeding problem.

3.If the FP otherwise considers it a normal part of being a newborn, then no code is necessary.

ICD-9 codes 760-779 are for conditions which have their origins in the perinatal period only, which occurs before birth through the first 28 days after. Look to codes outside this section for similar conditions for older patients.

Example: An FP notes that a 1-month-old (30 days) infant has low weight gain. On evaluation, the FP finds the infant to be below the normal average weight for his age.

The FP diagnoses failure to thrive.

In this case, 783.41 would be the appropriate code. Code 779.34 is for newborns 28 days old or younger.

When the FP specifies obstruction as a diagnosis, there may be no need to use 779.32. Bilious vomiting is inherently a part of intestinal obstruction and is the hallmark sign of the presence of intestinal obstruction.

Example: Three days after delivery, a newborn had vomiting of greenish gastric secretions and was feeding poorly. The FP who evaluates her gives a diagnosis of intestinal obstruction. Code this as:

• 751.1 -- Atresia and stenosis of small intestine

• 779.31 -- feeding problems in newborn.