Pediatric Coding Alert

Be ready to signify the cause of the croup under ICD-10.

Coding for children with croup has always been fairly straightforward because ICD-9 offers just one diagnosis code for the condition, which is 464.4. Fortunately, when ICD-10 takes effect next year, you’ll get the benefit of a one-to-one conversion.

Croup results from inflammation around the patient’s larynx and windpipe, causing a bark-like cough in pediatric patients. Currently, you report 464.4 (Croup) for this diagnosis, but under ICD-10, J05.0 (Acute obstructive laryngitis [croup]) will be your go-to code.

Here’s the change: One new rule will change under ICD-10, however. Effective Oct. 1, 2014, you’ll need to add a second diagnosis code to signify the cause of the disease. You’ll find this code in the B95-B97 range (Bacterial and viral infectious agents) category, with the following (among others) as your options:

·         B95.3 — Streptococcus pneumonia as the cause of diseases classified elsewhere

·         B96.3 — Hemophilus influenza [H. influenza] as the cause of diseases classified elsewhere

·         B97.4 — Respiratory syncytial virus as the cause of diseases classified elsewhere

·         B97.89 — Other viral agents as the cause of diseases classified elsewhere

Documentation: Practitioners will have to be diligent about recording the root cause of a patient’s croup, with notes in the patient record that detail the origin of the croup, such as “patient had been treated for RSV in the past week and although his symptoms improved, the patient’s parents noted that he was up all night with a bark-like cough and it has worsened over the past 24 hours.”

Coder Tips: On your superbill, place a line next to the croup diagnosis code where the pediatrician can write the infectious agent that led to croup. For instance, the superbill could be printed as follows:

J05.0 caused by the following infectious agent: ____________________________.