Pediatric Coding Alert

Pediatric expert shows you the diagnoses to add to your superbillYou'll add only the diagnoses you really need and won't unnecessarily cramp your diagnostic encounter sheet if you follow this short action plan that will prepare you for the ICD-9 changes that will take effect Oct. 1.1. Switch Plantar Wart Final Digit to "2"Look forward to having a code to specifically identify plantar warts (078.12, Plantar wart). "The new diagnosis for plantar's wart is a good one that pediatricians will want to list on their charge ticket," says Donelle Holle, RN, a Ft. Wayne, Ind. pediatric coding and reimbursement national speaker and consultant with more than 30 years of experience, including past director of professional services for the University of Michigan, Dept. of Pediatrics.Change: You currently have to lump plantar warts under other specified code 078.19 (Other specified viral warts). For destruction of plantar warts, which are benign tumors that occur on the sole, heel or ball of the foot and most often in children and young adults between the ages of 12 and 16, you'll use 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) or 17111 (... 15 or more lesions) with 078.12.Catch this: If you spot verruca plantaris in chart notes, equate this with plantar warts. The formal Latin term "verruca plantaris," which is an infection caused by human papilloma virus (HPV), will be moved from under 078.19 to under 078.12.2. Add Non-Mental Headache CodeYou might also want to add a headache code from the nervous system section to your diagnostic charge ticket. Pediatricians "might also use 339.10 (Tension type headache, not elsewhere classified)," Holle says.The current system misclassifies tension headache (307.81), which occurs in more than 50 percent of the population, as a psychiatric disorder, according to "Headache Classification 2007" presented by Stephen D. Silberstein, MD, FACP, past president of the American Headache Society, director of the Jefferson Headache Center and neurology professor at Thomas Jefferson University Hospital in Philadelphia (http://www.cdc.gov/nchs/ppt/icd9/att1_headache_mar07.ppt). New code 339.10 will exclude tension headaches due to psychological factors classified under 307.81.This will give you an ICD-9 code outside the signs and symptoms section (784.0, Headache) that will not trigger a mental health carve out. Because 307.81 is in this section, insurers may not cover the diagnosis due to considering it a mental health benefit that the patient's coverage may not offer.3. Beware of 7-Family Disruption V CodesIf your ICD-9 encounter sheet has a V code section for other services, consider including "Family Disruption V61.0X _______". "Pediatricians tend to do a lot of counseling when families are having problems prior to a referral to psychological [...]