Specialty Code Set Training Pediatrics - AAPC

ICD-10-CMSpecialty Code Set Training

Pediatrics2014

Module 4

ii ICD-10-CM Specialty Code Set Training — Pediatrics © 2013 AAPC. All rights reserved.080813

DisclaimerThis course was current at the time it was published. This course was prepared as a tool to assist the participant in understanding how to prepare for ICD-10-CM. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility of the use of this information lies with the student. AAPC does not accept responsibility or liability with regard to errors, omissions, misuse, and misinterpretation. AAPC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of information is error-free and will bear no responsibility, or liability for the results or consequences of the use of this course.

AAPC does not accept responsibility or liability for any adverse outcome from using this study program for any reason including undetected inaccuracy, opinion, and analysis that might prove erroneous or amended, or the coder’s misunderstanding or misapplication of topics. Application of the information in this text does not imply or guarantee claims payment. Inquiries of your local carrier(s)’ bulletins, policy announcements, etc., should be made to resolve local billing requirements. Payers’ interpretations may vary from those in this program. Finally, the law, applicable regulations, payers’ instructions, interpretations, enforcement, etc., may change at any time in any particular area.

This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or taping) without the expressed written permission from AAPC and the sources contained within.

Clinical Examples Used in this BookAAPC believes it is important in training and testing to reflect as accurate a coding setting as possible to students and examinees. All examples and case studies used in our study guides and exams are actual, redacted office visit and procedure notes donated by AAPC members.

To preserve the real world quality of these notes for educational purposes, we have not re-written or edited the notes to the stringent grammatical or stylistic standards found in the text of our products. Some minor changes have been made for clarity or to correct spelling errors originally in the notes, but essentially they are as one would find them in a coding setting.

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ICD-10 ExpertsRhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, CPEDC, CENTC, COBGC VP, ICD-10 Training and Education

Shelly Cronin, CPC, CPMA, CPC-I, CANPC, CGSC, CGIC, CPPM Director, ICD-10 Training

Betty Hovey, CPC, CPMA, CPC-I, CPC-H, CPB, CPCD Director, ICD-10 Development and Training

Jackie Stack, CPC, CPB, CPC-I, CEMC, CFPC, CIMC, CPEDC Director, ICD-10 Development and Training

Peggy Stilley, CPC, CPB, CPMA, CPC-I, COBGC Director, ICD-10 Development and Training

Contents

Commonly Coded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Bronchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Ear Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Crohn’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Dermatitis and Eczema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Atopic Dermatitis (AD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Seborrheic Dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Contact Dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Allergic Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47General Medical Examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

© 2013 AAPC. All rights reserved. www.aapc.com 37080813

Commonly CodedPediatricians treat patients with a wide variety of conditions and diseases. Some of the most commonly coded conditions for pediatrics have already been covered and will not be repeated here. Instead, other commonly coded conditions will be addressed: asthma, bronchitis, otitis media, diabetes, Crohn’s disease, dermatitis, allergic rhinitis, and general medical examinations.

AsthmaAsthma is a chronic lung disease that inflames and narrows the airways. People with asthma experience symptoms when the airways tighten, inflame, or fill with mucus. According to the American Lung Association, asthma is one of the most common chronic disorders in childhood, with an estimated 7.1 million children less than 18 years of age affected. It is the leading cause of absenteeism from school. Common asthma symptoms include:

� Coughing, especially at night � Wheezing � Shortness of breath � Chest tightness, pain, or pressure

In ICD-10-CM, the code set is expanded. It is subcategorized by severity. The subcategories are:

� J45.2- Mild intermittent � J45.3- Mild persistent � J45.4- Moderate persistent � J45.5- Severe persistent � J45.9- Other and unspecified asthma

The subcategories are further broken down by complication:

� Uncomplicated � With acute exacerbation � With status asthmaticus

With asthma, as with any condition that is located in chapter 10, Diseases of the Respiratory System, any exposure to tobacco should be separately reported.

EXAMPLEA patient with moderate persistent asthma presents to the office with a parent. She uses her rescue inhaler daily and is awakened by her asthma symptoms a few nights per week. She experiences some limitations of play due to her asthma. She is awakened multiple times a week by her symptoms and uses her rescue inhaler daily. At this visit she is tachypneic, with acute shortness of breath with audible wheezing. Patient has been given her prescribed

38 ICD-10-CM Specialty Code Set Training — Pediatrics © 2013 AAPC. All rights reserved.080813

Commonly Coded

medications of Cromolyn Sodium and Ventolin at home with no relief of symptoms prior to coming to the office. A physical exam revealed: HR 110, RR 40 with signs of accessory muscle use. Auscultation revealed decreased breath sounds with inspiratory and expiratory wheezing and patient was coughing up small amounts of white sputum. SaO2 was 93 percent on room air. Two nebulizer treatments were given, with improvement of peak flows. Re-exam indicates clearing of breath sounds and much improved airflow. Symptoms resolved and patient was given prescription for inhaled steroids to be used with current home meds. J45.41 Moderate persistent asthma with (acute) exacerbation

BronchitisBronchitis is a respiratory disease in which the mucus membrane in the lungs’ bronchial passages becomes inflamed. As the irritated membrane swells and gets thicker, it narrows or closes the bronchial passages in the lungs, resulting in coughing spells that may be accompanied by phlegm and breathlessness. In pediatric patients, acute bronchitis is usually found with a viral respiratory tract infection (approximately 90 percent of the time).

In ICD-10-CM, the codes for bronchitis are divided into the time parameters of acute and chronic. The acute bronchitis codes are further broken down by causal organism, as listed below.

� J20.0 Acute bronchitis due to Mycoplasma pneumoniae � J20.1 Acute bronchitis due to Hemophilus influenzae � J20.2 Acute bronchitis due to streptococcus � J20.3 Acute bronchitis due to coxsackievirus � J20.4 Acute bronchitis due to parainfluenza virus � J20.5 Acute bronchitis due to respiratory syncytial virus � J20.6 Acute bronchitis due to rhinovirus � J20.7 Acute bronchitis due to echovirus � J20.8 Acute bronchitis due to other specified organisms

The codes for chronic bronchitis are broken down by whether the bronchitis is simple, mucopurulent, or mixed.

� J41.0 Simple chronic bronchitis � J41.1 Mucopurulent chronic bronchitis � J41.8 Mixed simple and mucopurulent chronic bronchitis

Each subcategory includes an unspecified code. There is also a code, J40 Bronchitis, not specified as acute or chronic if the documentation does not specify a time parameter (diagnosis: bronchitis). This code should be avoided, if possible. As with asthma, any exposure to tobacco should be separately reported.


Commonly Coded

EXAMPLEFour-month-old Jake is brought in by his father for a hospital follow-up visit. Jake was taken to the ED by his mother and admitted due to breathing problems. Respiratory viral panel showed Jake to have acute bronchitis due to RSV. He had an eight-day hospital stay. He is doing very well today with minimal cough and easy breathing. J20.5 Acute bronchitis due to respiratory syncytial virus

Ear InfectionsEar infections are most common in infants and young children because the Eustachian tubes are narrower and shorter than in adults. This makes it easier for fluid to get trapped. According to the National Institutes of Health, three out of every four children experiences an ear infection by the time they are three-years-old. For many children, it is a recurrent issue with more than one third of children experiencing six or more episodes by age seven. It is the second most common disease of childhood behind upper respiratory infections.

According to the National Institutes of Health, the three main types of ear infections are acute otitis media, otitis media with effusion, and otitis externa. In ICD-10-CM, codes for diseases of the ear and mastoid process are located from category H60 through category H95.

The codes are broken down by the following:

� Temporal parameters � Whether the condition is recurrent � Laterality � Type

Otitis media is usually painful and patients have symptoms of redness in the eardrum, pus in the ear, and a fever. Acute otitis media is the most common ear infection. It is an infection of the middle ear space, behind the tympanic membrane. In some cases, symptomatic treatment will be used (over-the-counter pain relievers, eardrops) without the use of antibiotics. In other cases, antibiotics will be prescribed, such as Amoxicillin. The pediatrician will make the best decision based on many factors, including age of the child and severity of symptoms. If pus is present, it is called suppurative otitis media.

EXAMPLE Nate is a 10-month-old baby brought in by his mother. The child has been cranky, running a fever, and pulling at his left ear. The mother smokes in the house. Examination notes some pus, bulging TM, and inflammation of the left ear. Diagnosis is made of acute suppurative OM. H66.002 Acute suppurative otitis media without spontaneous rupture of ear drum, left ear Z77.22 Exposure to environmental tobacco smoke

Otitis media with effusion (OME) is when there is thick or sticky fluid behind the eardrum in the middle ear, without the presence of an ear infection. It may also be called serous otitis media or nonsuppurative otitis media. In most cases, children with OME do not act sick and often do not have obvious symptoms. It may be caused by viral upper respiratory infections, allergies, or


Commonly Coded

exposure to irritants (especially cigarette smoke). Since it is not caused by an infection, antibiotics are not usually used to treat OME. Providers will recheck the condition and try to eliminate triggers and take preventive measures.

EXAMPLETony is a 3-year-old male patient, presents to be seen with his mother. He has had bilateral OME multiple times since the age of one, with significant amounts of fluid accumulation in both ears. The ear complaints are worse during allergy season. The mother now presents with the child after she and the preschool teacher noticed that he is not responding well to auditory stimuli and is having speech troubles with pronunciation of certain words. Upon exam, both ears have nonpurulent effusion noted.Assessment: Recurrent acute allergic bilateral OME H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous),

recurrent, bilateral

Otitis externa (OE) is an infection in the ear canal and may be caused by fungi or bacteria. It is also called swimmer’s ear because it is commonly seen in children that spend a lot of time in the water. When too much moisture stays in the ear, it can irritate the skin in the canal, causing it to breakdown. This also allows bacteria or fungi to penetrate. This condition is more often seen in the summer. OE may also be caused by other factors that cause a break in the skin: eczema, vigorous ear cleaning with cotton swabs, scratching the ear canal, or inserting foreign objects (bobby pins, paper clips). Symptoms include ear pain, pain with chewing, itching of the ear canal, red swollen outer ear, pus draining from the ear may also be present.

EXAMPLE Susan is brought in by her mother. She has been swimming at the pool all week and started complaining of pain in her ears. She says she is having trouble chewing also. On examination, the outer ears appear reddened with a light secretion in both ears. The patient complains of pain with tragal pressure. She is diagnosed with bilateral Swimmer’s ear. H60.333 Swimmer’s ear, bilateral

Diabetes Mellitus Diabetes mellitus is a condition that occurs when the body can’t use glucose normally. Glucose is the main source of energy for the body’s cells. The levels of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas. Insulin helps glucose enter the cells. In diabetes, the pancreas does not make enough insulin (type 1) or the body can’t respond normally to the insulin that is made (type 2). This causes glucose levels in the blood to rise, leading to symptoms such as increased urination, extreme thirst, and unexplained weight loss. Diabetes mellitus is a chronic disease that causes serious health complications including renal failure, heart disease, stroke, and blindness.

According to the American Diabetes Association, the latest data released from the National Diabetes Fact Sheet (released Jan. 26, 2011), there are 25.8 million Americans living with diabetes. That is 8.3 percent of the population. This figure includes 18.8 million people diagnosed with diabetes, and 7 million people that are undiagnosed. There are 79 million people estimated to have prediabetes. Further breakdown of the figures states that about one in every 400 children and


Commonly Coded

adolescents has diabetes. Type 1 diabetes mellitus is more prevalent in children and adolescents, but type 2 diabetes mellitus is being diagnosed more often in children.

The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, the complications affecting that body system, and if the patient is on long term insulin if a non-type 1 diabetic patient. As many codes within a particular category as are necessary to describe all of the complications of the disease may be used. They should be sequenced based on the reason for a particular encounter. Assign as many codes from categories E08-E13 as needed to identify all of the associated conditions that the patient has.

For pediatricians, diabetes will be a common condition seen in the practice. The way diabetes is coded is different than in ICD-9-CM with the addition of combination codes. A thorough understanding of what to look for in the documentation and how it fits together for coding purposes is necessary in order to assign codes properly in ICD-10-CM.

There are five diabetes mellitus categories in the ICD-10-CM. They are:

� E08 Diabetes mellitus due to an underlying condition � E09 Drug or chemical induced diabetes mellitus � E10 Type 1 diabetes mellitus � E11 Type 2 diabetes mellitus � E13 Other specified diabetes mellitus

Definitions for the types of diabetes mellitus are included in the “Includes notes” under each DM category. Family practitioners should be instructed to document the type of diabetes as type 1 or type 2, when appropriate, and not insulin and non-insulin dependent as these terms are no longer used in the coding schema.

The subcategories for the complications with the body systems affected by diabetes mellitus are as follows:

� Ketoacidosis � Without coma � With coma

� Kidney complications (usually doesn’t appear until the child has reached puberty and has had diabetes for several years)

� Diabetic nephropathy � Diabetic chronic kidney disease � Other diabetic kidney complications

� Ophthalmic complications � Diabetic retinopathy (usually doesn’t appear until the child has reached puberty and

has had diabetes for several years)

» Mild nonproliferative with/without macular edema

» Moderate nonproliferative with/without macular edema


Commonly Coded

» Severe nonproliferative with/without macular edema

» Proliferative with/without macular edema � Diabetic cataract � Other diabetic ophthalmic complications

� Neurological complications (more likely to occur after puberty, but may appear at an earlier age in a patient with poor blood sugar control)

� Diabetic neuropathy

» Diabetic mononeuropathy

» Diabetic polyneuropathy

» Diabetic autonomic (poly)neuropathy � Diabetic amyotrophy � Other diabetic neurological complications

� Circulatory complications (overweight children are at a higher risk) � Diabetic peripheral angiopathy with/without gangrene � Other circulatory complications

� Other specified complications � Diabetic arthropathy

» Diabetic neuropathic arthropathy

» Other diabetic arthropathy � Skin complications

» Diabetic dermatitis

» Foot ulcer

» Other skin ulcer

» Other skin complication � Oral complications

» Periodontal disease

» Other oral complications � Hypoglycemia

» With coma

» Without coma � Hyperglycemia � Other specified complication

All the categories above with the exception of E10 Type 1 diabetes mellitus include a note directing users to use an additional code to identify any insulin use, which is Z79.4. The concept of


Commonly Coded

insulin and non-insulin requiring are not a component of the diabetes mellitus (DM) categories in ICD-10-CM. Code Z79.4 Long-term current use of insulin is added to identify the use of insulin for diabetic management even if the patient is not insulin dependent in code categories E08–E09 and E11–E13.

EXAMPLEMaria, a 10-year-old female, presents to the office with an approximate 10 lb. weight loss over the last few weeks, nausea, increased thirst, and urination. She denies abdominal pain. Her father has Type 1 DM and one cousin was diagnosed with Type 1 DM at age 18 months. Labs indicate a blood sugar of 411. She is admitted to the hospital and diagnosed with type 1 diabetes mellitus with hyperglycemia. E10.65 Type 1 diabetes mellitus with hyperglycemia Z83.3 Family history of diabetes mellitus

EXAMPLE14-year-old female with type 2 diabetes. Patient’s current and regular medications include NovoLog with each meal. E11.9 Type 2 diabetic mellitus without complications Z79.4 Long term (current) use of insulin

Sequencing of diabetes codes from categories E08–E09 have a “Code first” note indicating that diabetes is to be sequenced after the underlying condition, drug or chemical that is responsible for the diabetes. Codes from categories E10–E13 (diabetes mellitus) are sequenced first, followed by codes for any additional complications outside of these categories if applicable.

EXAMPLEJanet presents with her parents for cystic fibrosis-related diabetes check. She is doing well on her insulin and continues to consume the correct protein (15 percent) and fat levels (35 percent) daily. Eating a lot of fish and chicken and consuming extra salt when hot outside. Diagnosis: CFRD. Doing well. Labs before next visit. See back in 2 months. E84.8 Cystic fibrosis with other manifestations E08.9 Diabetes mellitus due to underlying condition without complications Z79.4 Long term (current) use of insulin

Crohn’s DiseaseThe exact cause of Crohn’s disease is unknown. It is a condition that occurs when your body’s immune system mistakenly attacks and destroys healthy body tissue, so it is an autoimmune disorder. Crohn’s most often affects the ileum, but it may affect any part of the gastrointestinal tract. The inflammation of the intestine can “skip” areas, leaving normal areas in between patches of diseased intestine.

This condition differs from ulcerative colitis in the fact that ulcerative colitis only affects the colon and it does not skip areas, like Crohn’s. According to the Pediatric Irritable Bowel Disease


Commonly Coded

Consortium, about 30 percent of children with Crohn’s disease have a close family member who also has Crohn’s.

The code set for Crohn’s has expanded in ICD-10-CM to include both site and complications. There is also an instructional note that states to use an additional code to identify manifestations. The small intestine, subcategory K50.0-, would include the duodenum, the jejunum, and the ileum. You may also see a notation of regional ileitis or terminal ileitis. The large intestine, subcategory K50.1-, would include terminology of the colon, large bowel, rectum, granulomatous colitis, or regional colitis. If both the small and large intestine are affected, then there is a combination subcategory, K50.8-.

The second factor for coding Crohn’s is the complications:

� Rectal bleeding (6th character 1) � Intestinal obstruction (6th character 2) � Fistula (6th character 3) � Abscess (6th character 4) � Other (6th character 8)

Completed code examples include:

� K50.00 Crohn’s disease of small intestine without complications � K50.113 Crohn’s disease of large intestine with fistula � K50.814 Crohn’s disease of both small and large intestine with abscess � K50.918 Crohn’s disease, unspecified, with other complication

If documentation does not indicate any complication, there are codes in each subcategory for “without complications.” Discussion of the new criteria with the pediatrician is important. If they are not educated on what is contained in the codes, documentation practices will not change. These complications will help indicate the severity of the patient’s conditions to a payer, indicating medical necessity. They may allow for certain testing or certain amount of visits, so it is important to code these things when they are present.

EXAMPLEEddie has Crohn’s disease of the ileum. He is brought in today by his mother with a complaint of rectal bleeding. K50.011 Crohn’s disease of small intestine with rectal bleeding

Dermatitis and EczemaDermatitis simply translated is inflammation of the skin, but there are different forms. In the early stages of dermatitis, most people experience red, dry, and itchy skin. If it progresses it may result in crusty scales or oozing blisters. We will discuss atopic dermatitis, seborrheic dermatitis, and contact dermatitis. The block of codes in ICD-10-CM that relate to dermatitis and eczema is L20–L30. There is a note for the code block that states that the terms dermatitis and eczema are used synonymously and interchangeably.


Commonly Coded

Atopic Dermatitis (AD)AD often appears before a child’s first birthday and usually appear as dry, red, itchy patches on the skin. The most common areas affected are the forehead, scalp, and face (especially the cheeks). According to the American Academy of Dermatology, this condition affects 10–20 percent of children worldwide, and 1–3 percent of adults. Risk factors include: allergies (personal or family history), asthma (personal or family history), or family history of AD.

In ICD-10-CM, codes for atopic dermatitis are located in category L20.

� L20.0 Besnier’s prurigo—AD may be associated with asthma, hay fever, or other allergic conditions, characterized by extreme itching, leading to scratching and rubbing that result in typical lesions of eczema.

� L20.81 Atopic neurodermatitis—AD characterized by localized or disseminated lichenified skin lesions that itch severely. May possibly be a psychogenic disorder as it is seen in nervous, anxious individuals.

� L20.82 Flexural eczema—AD that appears at the flexures of the elbows, knees, wrists, etc. � L20.83 Infantile (acute) (chronic) eczema—AD in infants � L20.84 Intrinsic (allergic) eczema—AD in patients with normal serum IgE levels. � L20.89 Other atopic dermatitis � L20.9 Atopic dermatitis, unspecified

EXAMPLESeven-year-old girl brought in for itchy, papular rash on the flexural surfaces of the neck, axillae, and elbows. No other family members with AD, but mother has asthma. Scratching of the lesions is worse at night. Patient with lichenification in left elbow area. Patient is diagnosed with flexural dermatitis. L20.82 Flexural eczema Z82.5 Family history of asthma and other chronic lower respiratory diseases

Seborrheic DermatitisSeborrheic dermatitis is a common, inflammatory skin condition that causes flaky, white to yellowish scales to form on oily areas such as the scalp or inside the ear. It can occur with or without reddened skin. When seborrheic dermatitis begins in infancy, it usually disappears between 6 months and 1 year. If the seborrheic dermatitis begins in adulthood, the condition may come and go for the remainder of the patient’s life.

In ICD-10-CM, codes for seborrheic dermatitis are located in category L21.

� L21.0 Seborrheic capitis—Seborrheic dermatitis that forms on baby’s scalps (also called cradle cap), forming scaly, greasy patches that may become thickened and crusty.

� L21.1 Seborrheic infantile dermatitis—Seborrheic dermatitis that appears on infants other than the scalp.

� L21.8 Other seborrheic dermatitis � L21.9 Seborrheic dermatitis, unspecified


Commonly Coded

EXAMPLEA new mother brings her infant in because she is worried about a yellowish, crusty deposit on the baby’s scalp. He is diagnosed with cradle cap. The mother is told to wash the baby’s hair once a day with a mild baby shampoo and brush gently with a soft brush to loosen the scales. L21.0 Seborrhea capitis

Contact DermatitisContact dermatitis is a skin reaction that occurs from exposure to external allergens (allergic contact dermatitis) or irritants (irritant contact dermatitis). Allergic contact dermatitis (ACD) occurs when a particular substance elicits a hypersensitive reaction within hours or days. Common causes in children are nickel, poison ivy, and latex. It may affect as much as 20 percent of the pediatric population. In adolescents, females are more likely to suffer from ACD. Itching is the main symptom with ACD. Irritant contact dermatitis (ICD) occurs when a particular substance that can cause an eruption in most people who come in contact with it elicits an inflammatory reaction within minutes or hours. Common causes in children are soaps, saliva, urine, and detergents. Mild redness, swelling of the skin, blistering of the skin, and itching are the main symptoms with ICD. According to the American Academy of Dermatology, irritant contact dermatitis accounts for most cases of contact dermatitis (around 80 percent).

In ICD-10-CM, the codes for allergic contact dermatitis and irritant contact dermatitis are located in categories L23 and L24. They are broken down by type and causative agent. Category L25 contains codes for unspecified contact dermatitis, broken down by causative agent only. It is important for the provider to document the type as the same causative agents may be found in different categories. For example, look at the following codes:

L23.0 Allergic contact dermatitis due to metals

L24.81 Irritant contact dermatitis due to metals

L23.2 Allergic contact dermatitis due to cosmetics

L24.3 Irritant contact dermatitis due to cosmetics

It is important to work with providers in order to assign the most appropriate codes in ICD-10-CM.

EXAMPLEKatie is brought in for a rash around her wrists and neck. Her grandmother bought her some costume jewelry at a children’s store in the mall yesterday. After the child wore the jewelry for a few hours, her mother noticed her scratching the areas. She made her remove the jewelry, but the child has continued to scratch the area. She is diagnosed with allergic contact dermatitis due to nickel and given medication to help with the itching. L23.0 Allergic contact dermatitis due to metals


Commonly Coded

Allergic RhinitisAccording to The American College of Allergy, Asthma, & Immunology, allergies—including allergic rhinitis—affect an estimated 40 million to 50 million people in the United States. Seasonal allergic rhinitis usually develops after six years of age, while perennial allergic rhinitis is commonly seen in younger children.

Rhinitis is a term describing the symptoms produced by nasal irritation or inflammation, which are due to blockage or congestion, including:

� Runny nose � Itching � Sneezing � Stuffy nose due to blockage or congestion

These symptoms are the nose’s natural response to inflammation and irritation and are often associated with itching of the eyes.

ICD-10-CM only contains a few codes for allergic rhinitis, but it is a condition commonly treated in pediatrics.

From a coding perspective, the codes specify causation.

� J30.1 Allergic rhinitis due to pollen (which includes hay fever) � J30.2 Other seasonal allergic rhinitis � J30.5 Allergic rhinitis due to food � J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander � J30.89 Other allergic rhinitis � J30.9 Allergic rhinitis, unspecified

EXAMPLEPaul is brought in by his mother for his allergic rhinitis. He is hypersensitive to pollen. His mother has been treating him with over the counter medications, but she says she does not think they are working properly as Paul still complains of congestion and eye irritation. Upon examination, Paul has “allergy eyes” and swollen nasal tissue. Paul is given a prescription for an intranasal corticosteroid. J30.1 Allergic rhinitis due to pollen

General Medical ExaminationsA large part of every pediatric practice is performing preventive medicine services. These include yearly physicals and immunizations.

Z00–Z13 contains codes for persons encountering health services for examination. This block of codes includes general medical examinations, special examinations, administrative examinations, and medical observation. For some of the subcategories in this block, there are two codes for each:


Commonly Coded

one for with abnormal findings and one for without abnormal findings. Other codes from chapter 21, like encounter for immunizations, or from other chapters may be reported along with the general examination codes, when applicable.

The main pediatric general and special examination codes that contain a “with” and “without” abnormal findings break down are:

� Z00.121 Encounter for routine child health examination with abnormal findings � Z00.129 Encounter for routine child health examination without abnormal findings � Z00.70 Encounter for examination in period of delayed growth in childhood without

abnormal findings � Z00.71 Encounter for examination in period of delayed growth in childhood with abnormal

findings � Z01.00 Encounter for examination of eyes and vision without abnormal findings � Z01.01 Encounter for examination of eyes and vision with abnormal findings � Z01.10 Encounter for examination of ears and hearing without abnormal findings � Z01.110 Encounter for hearing examination following failed hearing screening � Z01.118 Encounter for examination of ears and hearing with other abnormal findings

This block also contains codes for examination specific to pediatric issues that do not contain a break down by abnormal findings:

� Z00.110 Health examination for newborn under 8-days-old � Z00.111 Health examination for newborn 8 to 18-days-old � Z00.2 Encounter for examination for period of rapid growth in childhood � Z00.3 Encounter for examination for adolescent development state

The coding of immunizations is simplified in ICD-10-CM, as there is one code, Z23 Encounter for immunization. A note under code Z23 states that the procedure code is required to identify the types of immunizations given. The code is reported once on a claim, no matter how many or what type of immunizations are given. Code Z23 may be used as a secondary code if the inoculation is given as a routine part of preventive healthcare, like a well-baby visit.

EXAMPLEFive-year-old Jake is brought in for a well-child exam. He is doing well, reaching all the proper milestones, and a full examination is performed. Discussion is held in regards to proper child precautions in the home, seat belt usage, and wearing helmets while bike riding. Routine immunizations are given. Z00.129 Encounter for routine child health examination without abnormal findings Z23 Encounter for immunization


Commonly Coded

EXAMPLEA man brings his 6-month-old daughter in for her well-child check. During the exam, the pediatrician notices a rash on the baby’s trunk and a fever. The father states he did not notice it as the girl’s mother usually dressed the child. The pediatrician notes the rash is present on both sides of the baby’s trunk. The pediatrician decides to complete the preventive exam, but not give immunizations. He gives a prescription for rash and tells the father to leave the baby’s shirt off when possible, keep a check on the fever, give antipyretics if necessary, and have the baby brought back in one week. Z00.121 Encounter for routine child health examination with abnormal findings R21 Rash and other nonspecific skin eruption R50.9 Fever, unspecified

Documents

Specialty Code Set Training Pediatrics - AAPC