Pediatric Coding Alert

ICD-10 adds immunization counseling, more specificity to feeding difficulties.

Among the 191 new codes you’ll find in the 2022 ICD-10 code set are codes that describe some of the most common pediatric issues you deal with on a day-to-day basis with greater specificity than ever before. In addition, you’ll find a number of revisions to a lot of your most-used codes.

Here’s a brief look at some of the key code changes and their accompanying instructions that you’ll be able to use once they take effect on Oct. 1, 2021.

Capture Coughs Correctly With These New Codes

With winter illness season fast approaching, ICD-10’s expansion of R05 (Cough) to six new codes could not be more timely.

The new codes will now give you more specificity for this common symptom, giving you the choice of three levels of severity, from R05.1 (Acute cough) through R05.2 (Subacute cough) and R05.3 (Chronic cough). You’ll also be able to use R05.3 if your pediatrician documents persistent cough, refractory cough, or unexplained cough, as ICD-10 has added all three as synonyms for chronic cough.

You now also have R05.4 (Cough syncope) to document when a patient loses consciousness after a coughing bout, along with R05.8 (Other specified cough) and R05.9 (Cough, unspecified).

But remember: “You should avoid the unspecified code, R05.9, whenever possible in favor of a code with greater specificity,” says Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

Don’t forget to look closely at the instructions for this newly created code group, too, as these have also changed. R04.2 (Hemoptysis), or cough with hemorrhage, which was previously an Excludes1 code for R05, is now an Excludes2 code, while paroxysmal cough due to Bordetella pertussis (A37.0-) has become an Excludes1 code. And R05.4 comes with a Code first note to add syncope and collapse (R55) as a the first-listed diagnosis when the two are documented together and when applicable.

Add These New Neonatal Screening Codes

Next, you will need to remember to add a fourth character to P09 (Abnormal findings on neonatal screening) beginning October 1, as ICD-10 has expanded the code to provide more details about those abnormal findings. Moving forward, you’ll have the following codes at your disposal:

• P09.1 (Abnormal findings on neonatal screening for inborn errors of metabolism)
• P09.2 (Abnormal findings on neonatal screening for congenital endocrine disease)
• P09.3 (Abnormal findings on neonatal screening for congenital hematologic disorders)
• P09.4 (Abnormal findings on neonatal screening for cystic fibrosis)
• P09.5 (Abnormal findings on neonatal screening for critical congenital heart disease)
• P09.6 (Abnormal findings on neonatal screening for neonatal hearing loss)
• P09.8 (Other abnormal findings on neonatal screening)
• P09.9 (Abnormal findings on neonatal screening, unspecified)

In addition, instructions for the whole new code group now tell you to use an additional code “to identify signs, symptoms and conditions associated with the screening.”

Get Picky With These New Feeding Difficulty Codes

Also of special interest to pediatric coders is another breakout of an existing code into a whole new code group. You’ll find much greater specificity when documenting patients experiencing feeding difficulties now that R63.3 (Feeding difficulties) will go to a fifth character, enabling you to report R63.30 (Feeding difficulties, unspecified), R63.31 (Pediatric feeding disorder, acute), R63.32 (Pediatric feeding disorder, chronic), and R63.39 (Other feeding difficulties).

You’ll also need to pay attention to the synonym changes in this newly formed group, as “feeding problem (elderly) (infant) NOS” and “picky eater” have moved from parent code R63.3 to R63.39. The Excludes instructions for the group have also changed. Moving forward, F50.- (Feeding disorders), F98.2- (Other feeding disorders of infancy and childhood), and P92.- (Feeding problems of newborn) have been deleted as Excludes1 codes for R63.3- and added as Excludes2 codes for the whole new code group.

Don’t forget to code these conditions also: ICD-10 has also added instructions for R63.31 and R63.32 to code also associated conditions such as J69.0 (Pneumonitis due to inhalation of food and vomit), R13.1- (Dysphagia), K21.- (Gastro-esophageal reflux disease), and malnutrition conditions coded to E40-E46 when appropriate and if applicable.

And Get Ready to Give This New Immunization Counseling Code a Workout

Lastly, one new code that you’ll probably use immediately in your pediatric coding is Z71.85 (Encounter for immunization safety counseling). The ICD-10 code will pair with 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered) when your provider vaccinates any of your younger patients and educates them or their caregivers on the safety of the vaccine(s) they are administering.

But it will also pair with any other immunization administration service codes, including the numerous new COVID-19 vaccine administration codes, when your provider offers education regarding the safety of a particular vaccine. It may also be appropriate in some situations where vaccine counseling occurs but no vaccine is administered, such as 99401-99404 (Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure) …).

The code comes with Code also instructions to code an encounter for immunization (Z23) or immunization not carried out (Z28.-) as applicable, along with an Excludes1 note that you should use Z71.84 (Encounter for health counseling related to travel) instead if your provider’s immunization safety counseling is travel-related.