The Centers for Medicare & Medicaid Services (“CMS”) recently introduced the latest ICD-10 Clinical Concepts Series to help healthcare providers understand and adopt ICD-10 diagnosis coding comprehensively. Inspired by that series, we have compiled key information about a few diseases and their respective medical codes. In this article, we have shortlisted a few common diseases and medical coding guidelines for paediatricians.
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Abdominal Pain
Acute Bronchitis
Acute Pharyngitis
Allergic Inflammation of the Nasal Airways
Asthma
Chest Pain
(ICD-9-CM 789.00 to 789.09 range)
Abdominal pain is characterised by the pain felt in chest and groyne which is also usually referred to as the stomach region or belly. ICD-10-CM R10-R19 range is used to indicate the diagnosis of symptoms and signs involving the digestive system and abdomen.
There are 4 categories of abdominal pain:
Note that the abdomen has 4 sides and each side is indicated separately in the medical claims with different ICD-10 codes.
Following are the ICD-10-CM codes used to indicate the diagnosis of abdominal pain.
R10.0 Acute abdomen
R10.10 Upper abdominal pain, unspecified
R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
R10.2 Pelvic and perineal pain
(ICD-9-CM 466.0, 466.11, 466.19)
[Note: Organisms should be specified where possible]
A chest cold which is also often called acute bronchitis occurs when the lungs airways swell and produce excessive mucus in the lungs. This mucus prevents the air flow in the respiratory tract making it difficult for the patient to breathe. Acute bronchitis usually lasts less than 3 weeks.
The major causes of acute bronchitis include; bacteria, smoking, and allergies. It isn't suggested to take antibiotics in case of acute bronchitis.
Following are the symptoms of acute bronchitis which usually last 3 weeks:
ICD-10-CM codes for the diagnosis of acute bronchitis:
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
J20.9* Acute bronchitis, unspecified
(ICD-9-CM 034.0, 462)
Acute pharyngitis is an infection that is caused by viruses and bacteria. In many cases, it causes painful enlargement of the neck nodes (reactive lymphadenitis), since lymphoid tissue is also present.
The most common symptoms of acute pharyngitis include:
Usually, acute pharyngitis is diagnosed on the basis of the patient’s medical history and examination. It can be easily observed with a picture and its clinical characteristics that include; fever, general malaise, bad breath, cervical pain, etc.) make suspect a picture of acute pharyngotonsillitis.
However, in some situations, it is useful to perform some lab tests such as hemogram, globular sedimentation rate or determination of the level of antistreptolysins (ASLO). When certain infectious agents are suspected, a pharyngeal smear should be performed to culture the pharyngeal exudate. With this test, paediatricians can determine the germs that are causing the infection.
Following are the ICD-10-CM codes for acute pharyngitis:
J02.0 Streptococcal pharyngitis
J02.8 Acute pharyngitis due to other specified organisms
J02.9* Acute pharyngitis, unspecified
(ICD-9-CM 477.0 TO 477.9 range)
Allergic rhinitis (inflammation in upper nasal airways) and asthma (which is also known as allergic bronchitis, caused due to inflammation in lower nasal airways) are conditions of airway inflammation that often coexist.
These allergies are often caused due to common allergens like pollen, dander and mould spores. Common symptoms of allergic inflammation of the nasal airways include:
These symptoms can appear within a few minutes as soon as a child get exposed to allergens.
Your doctor will diagnose nasal inflammation based mostly on the history of your child’s given symptoms. You probably will be asked if your child has been going through stuffy nose (nasal congestion), runny nose, a cough, post-nasal drip, bad breath, headache, swelling around the eyes, or behaviour changes.
Usually, allergic inflammation in the nasal airways is also diagnosed by how long the symptoms last. If the child has a simple cold or flu then it will suffer from the same symptoms for 7 to 10 days. However, if the symptoms last longer than 10 days then it indicates that allergic inflammation has occurred and your child should be evaluated by a paediatrician.
ICD-10-CM J30-J39 range is used to indicate other diseases of upper respiratory tract including Vasomotor and allergic rhinitis, Chronic rhinitis, nasopharyngitis and pharyngitis, Chronic sinusitis, Nasal polyp, Other and unspecified disorders of nose and nasal sinuses, Chronic diseases of tonsils and adenoids, Peritonsillar abscess, Chronic laryngitis and laryngotracheitis, Diseases of vocal cords and larynx, not elsewhere classified, and other diseases of upper respiratory tract
Following are the ICD-10-CM codes for allergic inflammation of the nasal airways:
J30.0 Vasomotor rhinitis
J30.1 Allergic rhinitis due to pollen
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
(ICD-9-CM 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.81, 493.82 , 493.90, 493.91, 493.92)
The childhood asthma caused inflammation in the lungs and airways when your child is exposed to certain triggers i.e. inhaling pollen, catching a cold or respiratory infection. Childhood asthma is characterised by the following symptoms:
However, in some when children pathogens can cause dangerous attacks to your children. Although, childhood asthma is not so quite different from adult asthma but children have to face unique challenges. Because sometimes your child’s condition can lead them for emergency department visits, hospitalizations and missed school days.
Unfortunately there is no permanent treatment for childhood asthma and the symptoms keep continuing till adulthood. However, there are treatments that can keep the symptoms of childhood asthma under control and prevent damage to growing lungs in children.
Following are the ICD-10-CM codes for childhood asthma:
J45.20 Mild intermittent asthma, uncomplicated
J45.21 Mild intermittent asthma with (acute) exacerbation
J45.22 Mild intermittent asthma with status asthmaticus
J45.30 Mild persistent asthma, uncomplicated
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.40 Moderate persistent asthma, uncomplicated
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.50 Severe persistent asthma, uncomplicated
J45.51 Severe persistent asthma with (acute) exacerbation
J45.52 Severe persistent asthma with status asthmaticus
J45.901* Unspecified asthma with (acute) exacerbation
J45.902* Unspecified asthma with status asthmaticus
J45.909* Unspecified asthma, uncomplicated
J45.990 Exercise induced bronchospasm
J45.991 Cough variant asthma
J45.998 Other asthma
(ICD-9-CM 786.50 TO 786.59 range)
Chest pain in children doesn’t tend to be as dangerous as it is with adults. Because adult chest pain is usually associated with heart attack and other acute heart conditions. On the other hand, chest pain in children could be due to the following reasons:
Following are the ICD-10-CM codes for chest pain.
R07.1 Chest pain on breathing
R07.2 Precordial pain
R07.81 Pleurodynia
R07.82 Intercostal pain
R07.89 Other chest pain
R07.9* Chest pain, unspecified
The following guidelines would help you understand how you could determine accurate ICD-10-CM codes and apply them to prepare billable medical claims. Please note that a slight error of medical codes not only make your medical claims end in denials and rejections but it can also make you face legal consequences for fraud activities.
Therefore, these guidelines would help you identify areas of problem with your paediatric medical coding services and understand how to eliminate them.
Here are the most effective paediatric medical coding guidelines:
ICD-10 terminology used to describe some specific paediatrics procedures and diagnoses of diseases have been updated in the current classification system.
For example, paediatricians should also the following things while preparing documents for asthma:
Another example of updated terminology is “Underdosing”. It is a new concept in ICD-10-CM which is used to identify if a patient is taking less medicine than is prescribed. Paediatric medical coders and practitioners should mention the following details to document underdosing:
It is important to document the specific details of the diagnosis of several diseases such as diabetes mellitus, injuries, well-child exams and screening, otitis media, bronchitis and bronchiolitis and feeding problems of the newborn.
For example, when you’re documenting diabetes Mellitus then you should also use modifiers to reflect the type of diabetes mellitus, the body system affected, and the complications affecting the body system of the patient.
Moreover, if you’re applying paediatric medical codes for the following diseases then you should include the following details;
Injuries: When documenting medical codes for injuries then include a greater level of details about that injury i.e. episode of care, injury site (be as specific as possible), aetiology how was the injury sustained (e.g. sports, motor vehicle crash, exposure?), and place of occurrence e.g. School, work, etc.
Well Child Exams & Screening: ICD-10 has improved the quality of data collection for well child exams, early screening and the diagnosis of childhood diseases. Paediatric medical billing and coding specialists should include the following information for documentation;
The latest version of ICD-10-CM has introduced additional code selections for the feeding conditions of newborn babies. The new alternatives of these codes indicate different conditions i.e. difficulty feeding at breast, overfeeding, regurgitation and rumination, slow feeding, underfeeding, other feeding problems of the newborn, and other feeding problems of the newborn, unspecified.
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