Pediatric Coding Alert

And see what to do when a child is exposed to COVID-19 in utero.

It’s not always clear when and whether to code congenital conditions. The conditions themselves range in complexity and likelihood to recur. Some are uncommon and therefore include unfamiliar codes sets, while others confound coders by depending on pregnancy or delivery details.

Here are three frequently asked questions to help you feel more confident deciphering the correct protocols for correct congenital coding.

Should I code for corrected gastroschisis when the patient comes in complaining of stomach pain?

Answer: Whether you report Z87.761 (Personal history of (corrected) gastroschisis) depends on whether the pediatrician connected the gastroschisis with the presenting problem. Many congenital conditions can recur and, therefore, may require continued monitoring, which means personal history codes can absolutely help round out a patient record. However, before you report them, you should, make sure the physician has first clearly connected the current symptoms with the congenital condition. Then, you’ll need to make sure the physician has adequately documented them, having spent time or expertise evaluating it.

This rationale is evidenced in ICD-10 Official Guideline I.C.17, which says, “Codes from Chapter 17 [Congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)] may be used throughout the life of the patient. If a congenital malformation or deformity has been corrected, a personal history code should be used to identify the history of the malformation or deformity.” ICD-10 also reminds coders of this under certain specific codes. For example, take Z71.87 (Encounter for pediatric-to-adult transition counseling), which was new for 2023. “The guidance for that code reminds us to code also chronic conditions. The examples listed there include congenital malformations of the circulatory system (Q20-Q28),” says Jan Blanchard, CPC, CPEDC, CPMA, pediatric solutions consultant at Physician’s Computer Company in Winooski, Vermont.

Notice also guideline I.C.17 says the chapter 17 code may be used, but that doesn’t mean it must be used. Gastroschisis (Q79.3) is a birth defect that causes an opening in the skin and muscles that cover the abdominal wall, allowing intestines and sometimes other organs to bulge outside the body. This is corrected with one and, sometimes, two surgeries. It’s possible that as these patients get a little older, they may start having trouble absorbing nutrients or might suffer from acid reflux. It’s up to the physician to make that determination and indicate a connection when they document the encounter.

If the pediatrician documents congenital syndactyly of the toes during a child’s routine wellness check, which diagnosis code should I report?

Answer: Though it’s a fairly common condition affecting approximately 1 out of every 2,500 people, many pediatric coders won’t ever have to code for syndactyly. This is why syndactyly coding questions are common. Which code you report has to do with details your pediatrician provides. But first, you need to understand the condition itself.

Condition refresh: Congenital syndactyly is a condition where a patient’s fingers or toes are either fused or webbed. Naturally, depending on severity, this condition can affect a child’s dexterity if the fingers are fused or webbed, and can affect a child’s ability to run or walk normally, especially if it involves the big toe.

This question asks specifically about the toes, but unless there is more information, you cannot assume whether the patient’s toes are webbed or fused.

Here’s the difference: Webbed toes are also referred to as partially fused, because they’re typically only connected for part of the way up the toe. Fused toes, however, are completely connected. It’s up to the physician to make the clinical determination of whether the patient has webbed or fused toes.

You also have the option of reporting a code for polysyndactyly, which is when a patient has an extra toe fused to one of their toes. And in cases when you cannot get more information from the doctor about the condition, you can report a code for unspecified syndactyly.

Depending on the ultimate diagnosis, you’ll likely choose from the following codes when reporting syndactyly:

• Q70.2- (Syndactyly; Fused toes)
• Q70.3- (Syndactyly; Webbed toes)
• Q70.4 (Polysyndactyly, unspecified)
• Q70.9 (Syndactyly, unspecified)

Extra character alert: Note that the Q70.2 and Q70.4 codes have a dash after the final character. That’s because these codes require a 5th character to denote the affected foot. The 5th character options are:

• 0: Unspecified foot
• 1: Right foot
• 2: Left foot
• 3: Bilateral

So, for example, if your patient has webbed toes on their left foot, you’ll report Q70.32 to represent the diagnosis.

When coding a vaginal delivery where the mother previously had COVID-19, do I need to code that a neonate was exposed to COVID-19 in the womb if the child did not test positive for the disease?

Answer: Whether you code Z20.822 (Contact with and (suspected) exposure to covid-19) along with Z38.00 (Single liveborn infant, delivered vaginally) will depend on whether the mom tested positive for COVID-19 at the time of the child’s birth.

If she didn’t, then Z20.822 would be unnecessary. If she did, then you should code for COVID-19 exposure if the neonate did not test positive for the condition.

Note: If the newborn did test positive, then you would follow ICD-10 guideline I.C.16.h, which tells you to code U07.1 (COVID-19) along with P35.8 (Other congenital viral diseases) if the condition was contracted in utero.

And remember: The guideline also goes on to tell you that “when coding the birth episode in a newborn record, the appropriate code from category Z38 [Liveborn infants according to place of birth and type of delivery], should be assigned as the principal diagnosis.” This would be true regardless of the newborn’s COVID-19 status.