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Remember Measles? It's Back!

Measles is making a comeback. The Centers for Disease Control and Prevention (CDC) recently reported 477 confirmed cases of the measles (rubeola) in the first six months of 2014. A graph created by the CDC shows the rapid increase in cases and outbreaks this year compared to past years.
Measles was deemed “eliminated” in the United States in 2000, but remains vulnerable because the disease is still prevalent in many parts of the world, and travelers continue to bring it into the country. The Philippines, for example, is experiencing a large, ongoing measles outbreak, which has led the CDC to issue a Travelers’ Health Notice.
Look for the Signs
Providers should be on the lookout for measles, the CDC advises. Measles is an acute viral respiratory illness. Indications include:

  • Fever
  • Malaise
  • Cough
  • Coryza (rhinitis)
  • Conjunctivitis (pink eye)
  • Pathognomonic enanthema (Koplick’s spots) –  Little spots inside the mouth that are surrounded by a red ring.
  • Maculopapular rash – A combination of both macules (flat, discolored areas) and papules (small, raised bumps).

Complications of measles may  include:

  • Otitis media (middle ear infection)
  • Bronchopneumonia
  • Laryngotracheobronchitis (croup)
  • Diarrhea

Procedure Coding
There is no treatment for measles, but the provider may treat the symptoms, for which an appropriate evaluation and management code can be reported.
The majority of reported cases occurred in unvaccinated people. The CDC recommends the Measles-Mumps-Rubella (MMR) and Varicella (VAR) vaccines, or the combination Measles-Mumps-Rubella-Varicella (MMRV) vaccine, for children 1-12 years of age, given in two separate doses: the first dose at 12-15 months of age and the second dose at 4-6 years of age.
For this service, you would report the appropriate CPT® vaccine product code:

  • 90705 Measles virus vaccine, live, for subcutaneous use
  • 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use
  • 90708 Measles and rubella virus vaccine, live, for subcutaneous use
  • 90710 Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use

Remember to also code the administration of the vaccine (90460-90474).
Diagnosis Coding
Measles is classified to ICD-9-CM category 055. The fourth digit depends on whether the patient experienced a complication, such as:

  • 055.0 Postmeasles encephalitis
  • 055.1  Postmeasles pneumonia
  • 055.2  Postmeasles otitis media
    • 055.71  Measles keratoconjunctivitis
    • 055.79  Measles with other specified complications
  • 055.8  Measles with unspecified complication

Assign 055.9 for measles without mention of complication.
ICD-10-CM coding is similar, but with a few more options:

  • B05.0 Measles complicated by encephalitis
  • B05.1  Measles complicated by meningitis
  • B05.2  Measles complicated by pneumonia
  • B05.3  Measles complicated by otitis media
  • B05.4  Measles with intestinal complications
    • B05.81 Measles keratitis and keratoconjunctivitis
    • B05.89  Other measles complications

Assign B05.9  for measles without mention of complication.

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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