Pediatric Coding Alert

Note: Medicaid contractors are working to meet ICD-10 deadline.

If you're like most pediatric staffers, you've got the "unspecified jaundice" code 774.6 memorized. However, that code will be but a memory when ICD-10 takes effect on Oct. 1, 2013. Take a look at how your jaundice coding will change in less than two years.

Jaundice is a condition caused by a buildup of bilirubin in a patient's blood, and in newborns, it most commonly occurs within the first few days after birth. The condition causes a yellowish hue to the skin and typically resolves on its own, but in some cases, requires further treatment.

Current way: Under ICD-9 rules, you have just one code for unspecified neonatal jaundice, 774.6. You report this code unless the physician identifies a cause for the jaundice (such as being due to breast milk inhibitors, which would be 774.39). In the majority of cases, however, infants' cases of jaundice are unspecified in nature and you code them with 774.6.

ICD-10 Changes: When the ICD-10 transition takes place, you will fortunately benefit from a one-to-one transition for your unspecified jaundice cases and you'll turn to P59.9 (Neonatal jaundice, unspecified) when the physician documents that a patient has jaundice that isn't due to any specific cause. If a cause is identified in the notes, you'd report that instead. For instance, if the patient's jaundice is due to breast milk inhibitor, under ICD-10 you'd report P59.3. However, most jaundice cases fit into the "unspecified" territory.

Documentation: As in the past, physicians have needed to document whether a patient's jaundice is caused by a more specific condition, but if the pediatrician simply documents "neonatal jaundice," P59.9 will be your best option.

Coder Tips: Scratch out 774.6 on your superbills as Oct. 1, 2013 closes in, and replace it with the new ICD-10 code P59.9.

Medicaid Contractors Are Getting on Board With ICD-10

You may have heard that the AMA has taken a stand against the upcoming diagnosis coding system, which led the AMA's House of Delegates to formally request a repeal to ICD-10 during the group's Nov. 15 meeting.

Keep in mind: This does not mean that ICD-10 won't go into effect, but it does mean that the AMA is trying to find a workaround to avoid the resources that each practice will have to put into the ICD-10 migration. A formal ICD-10 repeal could only take place following governmental intervention.

CMS's response: During a Nov. 17 "ICD-10 Implementation" call, CMS's Denise Buenning responded to a question about whether ICD-10 will actually be delayed or eliminated. "There is no truth to the rumor, there is no pushback--the date for ICD-10 remains Oct. 1, 2013," she said.

This means you'll need to be ready to use the new code set by Oct. 1, 2013, but fortunately, medical practices aren't the only ones working hard to meet the deadline. Contractors, vendors, and individual states are steadily readying their systems for ICD-10 claims processing.

Medicaid: Because Medicaid rules and policies vary on a state-by-state basis, some practices may be expecting states to be on different pages when it comes to ICD-10 implementation. But that would be an inaccurate assumption, CMS reps said during a Nov. 17 "ICD-10 Implementation" call.

"I can tell you that most states are still conducting impact analyses and gathering business requirements for the things needed to accommodate the implementation of ICD-10," said CMS's Elizabeth Reed during the call. "CMS currently conducts bi-weekly calls with the states and is currently offering state-specific technical assistance training. I would encourage providers to get on their respective state list serves to stay in tune with state communications and testing requirements," she added.

Procedure coding: ICD-10 has a specific code set for procedures, known as ICD-10-PCS, which will be applied for inpatient claims. Fortunately, however, office-based pediatricians won't have to worry about using the procedural codes, known as ICD-10-PCS, because this code set will only be used for inpatient hospital claims, said CMS's Pat Brooks during the call.

"ICD-10-PCS will not be used on physician claims, even those for inpatient visits," Brooks told the callers. In addition, ICD-10 implementation has "no impact on CPT® or HCPCS coding--they will continue to be used as they are now."