Pediatric Coding Alert

Whether you’re new to pediatrics or a seasoned coder, a little review can be a big help. Pediatric practices see a lot of infants, so we’ve compiled three common problems to help you brush up on your skills as an infant care coder.

Code Feeding Difficulties With Ease

Many parents experience challenges when feeding their newborn or infant. Often, these challenges result in a trip to the pediatrician, but how should you code them? You’ll find several ICD-10 codes to choose from, and which ones you report will depend on the age of the child and the specific problem.

Newborns and nursing: An 8-day-old presents with trouble nursing. The mother explains the baby eats slowly and briefly then vomits white liquid shortly after being burped. Bowel movements are normal and the pediatrician determines there are no GI problems.

You’ll find feeding difficulty codes in the R63.3- (Feeding difficulties) and F50.- (Eating disorders) groups, but you’ll see those codes are only for patients over 28 days old. For neonates, you’ll turn to the P92 (Feeding problems of newborn) block. For this particular instance, breastfeeding is the particular concern, which would code to P92.5 (Neonatal difficulty in feeding at breast). Which code you report will depend on the details the provider included in the documentation. To report the vomiting, turn to P92.1 (Regurgitation and rumination of newborn).

Coding alert: Be aware that while P92.01 (Bilious vomiting of newborn) might seem like a good choice to code the child’s vomiting in this scenario, the bile would cause the vomit to have a yellow or green color instead. That’s why P92.1 is a better choice for this encounter as the child’s vomit is a whitish color. On similar note, P92.09 (Other vomiting of newborn) is technically accurate, but much less specific than P92.1 and, therefore, not the preferred choice.

Infants over 28 days old: Because feeding difficulties are common beyond 28 days, you’ll want to consider the R63.3- codes for children in this age group. Depending on the last time you used these codes, you may or may not remember this code set was expanded in 2021. When reporting feeding difficulties, remember to code to the 5^th character, depending on what details the provider included in the documentation. Choose from the following:

• R63.30 (Feeding difficulties, unspecified)
• R63.31 (Pediatric feeding disorder, acute)
• R63.32 (Pediatric feeding disorder, chronic)
• R63.39 (Other feeding difficulties).

Coding alert: 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. “Note that ICD guidance relaxed in October 2022 related to this code combination. The Excludes relationship between P92 and R63.3 moved from Excludes1 to Excludes2. Encounters dated Oct. 1, 2022 and after should not be automatically rejected for reporting those codes together”, advises Jan Blanchard, CPC, CPEDC, CPMA, of Physician’s Computer Company in Winooski, Vermont.

Refresh Your Memory of Diaper Rash Coding

Diaper rashes are caused either by irritants such as urine or feces, allergic reactions to diaper materials or baby wipes, or yeast infections; and which code you select depends on what kinds of details are provided. Diagnosis coding for the condition is usually as simple as L22 (Diaper dermatitis), which covers diaper erythema, diaper rash, and psoriasiform diaper rash.

In the case of a yeast infection, however, you’ll also want to code B37.2 (Candidiasis of skin and nail), which lists L22 as an Excludes2 code. That means that both conditions can occur at the same time, enabling you to code both together. In terms of sequencing, if the etiology of the diaper rash is known to be yeast, and the infectious agent is the subject of the treatment, B37.2 would be the primary diagnosis.

Capture the Correct Codes for Coughs

With winter often lasting well into these first few months of the year, it’s a good idea to have your R05 (Cough) codes handy. Again, which codes you choose from this code set will depend on the provider’s documentation. The cough codes, which you probably remember were expanded in 2021, are as follows:

• R05.1 (Acute cough)
• R05.2 (Subacute cough)
• R05.3 (Chronic cough)
• R05.4 (Cough syncope)
• R05.8 (Other specified cough)
• R05.9 (Cough, unspecified)

It’s up to the pediatrician to assign a cough as acute, subacute, or chronic; but if the notes say the infant’s cough is persistent, refractory, or unexplained, ICD-10 considers those all synonyms for chronic cough. This means if any of those descriptors are in the notes, it’s safe to report R05.3.

Note: Reporting R05.4 is appropriate when a patient loses consciousness after a coughing bout.

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.