Wiki Pediatric coding of L44.4

[pakalis]

We have rec'd 2 denials for a 99214 with ICD-10 code of L44.4 for age. Our patient is 11 years old. My understanding is that this icd-10 code is for pediatric 0-17, which this patient clearly falls into.
Has anyone else had any issue with this?
Thanks,
Paula Akalis, CPC

 

[Cynthia Hughes]

This code should not deny based on patient age. If not already resolved, recommend contacting payer to determine the exact reason for denial. It is possible that the word "infantile" in the code descriptor has lead to an inappropriate denial based on age. There is Medscape article on Gianotti-Crosti that states the epidemiology by age is onset of the eruption typically occurs in children aged 3 months to 15 years, with an average age of 2 years and a peak incidence at 1-6 years. Adult cases are rare but have been reported in women aged 17-46 years (http://emedicine.medscape.com/article/1111108-overview#a6). If it is necessary to provide literature to have an age-related edit changed, there are references in the Medscape article.