Wiki Pediatric BMI age discrepency

[lorenc00]

Hi,
Sorry if there is already a thread on this. There appears to be a conflict in the BMI category in ICD-10 for pediatric patients. A note at Z68 states that BMI pediatric codes are for use for persons 2-20 years of age; but the "P" symbol beside the pediatric BMI codes Z68.5- indicates for pediatric age 0-17.

When we use the pediatric BMI codes for a 20 year old patient our system gives an edit for age. When we then try to use an adult code the system again edits for age - a catch 22 loop we can't bypass.

We need to correct the system edit but I'm not sure of the best code subcategory. I'm leaning toward "adult" because the "A" symbol indicates adult age is 15-124. Has anyone else run into this situation?

Why does ICD-10 have those contradictory age notes at the category? Or maybe it's just me that's confused

 

[Cynthia Hughes]

The age indications that you are seeing ("A" and "P") are probably indications of the Medicare Code Editor (MCE) used in processing Medicare claims for facilities. These are not found in the ICD-10-CM code set published by NCHS and may or may not be used in processing non-facility claims and claims to payers other than Medicare.

Not sure that will help is your system integrates the MCE edits but if the edits do not apply to your claims, perhaps they can be turned off.

 

[DALLEN1]

Pediatric BMI discrepency

Thank goodness someone else has the same questions I do. You are right the guidelines in the book contradict each other and we are having claims deny stating diagnosis inconsistent with patient's age. We have a good portion of our patient volume is Medicaid and I would think they would follow the same guidelines as Medicare since they are both under CMS. Can anyone give insight? I think I will call a couple of the MCO for Medicaid to see what their response is. Thanks

 

[Cynthia Hughes]

Age edits will be deleted 0ctober 01, 2016

Thank goodness someone else has the same questions I do. You are right the guidelines in the book contradict each other and we are having claims deny stating diagnosis inconsistent with patient's age. We have a good portion of our patient volume is Medicaid and I would think they would follow the same guidelines as Medicare since they are both under CMS. Can anyone give insight? I think I will call a couple of the MCO for Medicaid to see what their response is. Thanks

The final rule for inpatient payment includes removal of some of the outpatient code edits that cause issues in reporting including the following.
"After consideration of the public comments we received, we are finalizing our proposal to remove the four ICD-10-CM diagnosis codes displayed earlier in this section that identify the body mass index for pediatric patients from the pediatric diagnosis category on the Age conflict edit code list in the ICD-10 MCE Version 34, effective October 1, 2016."

In the meantime, one must still appeal any denials based on ICD-10-CM instructions which are part of the HIPAA code set and thus applicable to both physicians and payers.

Hope that helps,
Cindy