Pediatric Coding Alert

Get your HFMD claims paid faster than it can spread.

With school back in full swing and cold and flu season now the major focus, it’s easy to forget about other common illnesses until they appear in your pediatric waiting room.

Hand, foot, and mouth disease (HFMD), typically resulting from the coxsackievirus, is a generally mild condition that predominantly affects children, though it can occur in individuals of any age. It is highly contagious, spreading easily through person-to-person contact and airborne particles. The disease is characterized by oral sores and a rash on the hands and feet.

While there is no targeted treatment for this condition, symptoms usually resolve on their own within a week to 10 days.

Read on to learn more about coding this highly contagious disease.

Recognize the Sign and Symptoms

Symptoms of HFMD typically manifest between three to six days post-infection. The disease may present a range of symptoms, or just a few, varying from case to case. Infants and toddlers may exhibit irritability and restlessness. Children of any age may experience fever and sore throat, often leading to a loss of appetite and general discomfort or fatigue. A day or two following the onset of fever, painful sores resembling blisters may develop in the mouth, including the tongue, gums, and inner cheeks.

Simultaneously, a non-itchy rash may appear on the hands, feet, and occasionally, the buttocks. If the rash does contain blisters, the color of these can vary from red, white, or gray depending on the individual’s skin tone. It may also present as tiny bumps. This disease is very contagious, allowing it to spread quickly among young children attending school or daycare centers.

Know the Role of Coxsackievirus and HFMD

Coxsackievirus is spread through contact with an infected person’s saliva, mucus, or stool. It can also be transmitted through contaminated surfaces or objects. Because HFMD is caused by coxsackievirus, an enterovirus, and can appear in and around the mouth, the palms of the hands, and the soles of the feet, for this reason, the condition is often known colloquially as hand, foot, and mouth disease.

Understand How to Code HFMD

To correctly code for HFMD, you will report B08.4 (Enteroviral vesicular stomatitis with exanthem) caused by the coxsackievirus. This code refers to the disease that presents as described above.

However, you’ll report B34.1 (Enterovirus infection, unspecified) when the patient has a confirmed coxsackievirus infection, but the specific presentation is not reported in the medical record.

Check the index: If the pediatrician diagnoses a patient with “hand, foot, and mouth disease,” be careful how you search the ICD-10-CM Alphabetic Index. Searching by the first word, “hand,” you get “hand-foot syndrome,” and instruction to see L27.1 (Localized skin eruption due to drugs and medicaments taken internally), which is not the correct code for coxsackie virus.

The correct path to B08.4 in the ICD-10-CM book is as follows:

• Go to the main Alphabetic Index for diseases.
• Search for the main term Disease.
• Find the subterm hand, foot, and mouth.
• This leads you directly to code B08.4.

Code This Scenario

The patient, a 3-year-old child, is brought into their family pediatrician’s office by their parent with symptoms of a mild fever, sore throat, and a rash covering their hands and feet. Dr. Allan performs a detailed history and examination of the patient. The child is diagnosed with HFMD.

The physician advises the parent on proper home care, which includes keeping the child hydrated, managing the fever and sore throat with acetaminophen, and preventing the spread of HFMD through frequent hand washing, disinfecting surfaces, and quarantining the child as they are able for the next five to 10 days or until their symptoms improve. The parent had a few follow-up questions, and the time spent with the patient was about 27 minutes.

Here are the appropriate codes for this scenario:

• 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.) for the office visit portion
• B08.4, which is the diagnosis code for HFMD

Don’t Confuse the Condition Due to Similar Symptoms

In cases where sores develop at the back of the oral cavity and throat, it could potentially be a related viral condition known as herpangina. This disease is often accompanied by a sudden spike in body temperature and, in some instances, seizures. It’s uncommon, but sores can also appear on the hands, feet, or other body parts.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC