Pediatric Coding Alert

Determine whether you’ll be ready for the new coding system with this sample note.

Although you’re probably a professional at coding your pediatric documentation at this point using ICD-9 codes, chances are high that you haven’t yet coded a note using only ICD-10 codes. Test yourself using this documentation example to determine whether you can select the right diagnosis codes, which will be required as of Oct. 1. Determine which ICD-10 codes you would report, then read on for the answers.

Scenario: An eight-year-old established patient presents for a well child visit. While there, the patient’s mother says that the child has recently needed to use his asthma inhaler twice a week, which has limited his activities of daily living to a slight extent, including his need to sit on the bleachers during his physical education class. Although the patient has had mild persistent asthma for a while, this is the first exacerbation that the parent has reported. Which ICD-10 codes should you report for this visit?

Coding solution: When the patient presents for a well visit and the pediatrician diagnoses an exacerbation of his mild persistent asthma, you’ll report the following codes:

• Z00.121 (Encounter for routine child health examination with abnormal findings) linked to the CPT® code for the well child visit (such as 99393, Periodic comprehensive preventive medicine reevaluation and management…late childhood [age 5 through 11 years]). 
• J45.31 (Mild persistent asthma with [acute] exacerbation) linked to the sick visit code, such as 99213 (Office or other outpatient visit for the evaluation and management of an established patient…). You’ll also append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to this office visit code to differentiate it from the well child visit code.

Tip: Remember that any time you report Z00.121 with a well child visit, you’ll need an additional ICD-10 code to reflect the “abnormal finding” indicated by Z00.121’s descriptor. That’s because the current code V20.2 that you’re using under ICD-9 will split into two separate codes under ICD-10. The first is Z00.129 (Encounter for routine child health examination without abnormal findings), which you’ll report if a well child visit results in a completely clean bill of health for the child. The second is Z00.121, which you’ll bill when a problem is found during the visit.

Coding analysts are hoping that the existence of Z00.121 will help bolster claims that include both a well child visit and a sick visit, because this diagnosis code tells the payer that the patient presented for a routine evaluation but that the provider found a problem during the visit.