Get a Handle on Hand, Foot, and Mouth Disease
Question: A parent brings their 4-year-old child to the family pediatrician’s office after the child develops a mild fever, sore throat, and a rash on their hands and feet. The parent notes that the child recently started attending a new daycare, where several common childhood illnesses have been circulating. Dr. Tanya performs a detailed history and examination and diagnoses the child with hand, foot, and mouth disease (HFMD). Dr. Tanya then discusses supportive home care with the parent, including encouraging fluids to maintain hydration and using acetaminophen as needed to manage the fever and throat discomfort. The physician also reviews ways to reduce the spread of HFMD, such as frequent hand washing, cleaning and disinfecting commonly touched surfaces, and keeping the child home as much as possible for the next five to 10 days or until their symptoms improve. The parent asks several follow-up questions, and the total time spent with the patient is approximately 25 minutes. How should this visit be coded? Indiana Subscriber Answer: To code this visit, you would look to 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 evaluation and management (E/M) portion. You would add ICD-10-CM code B08.4 (Enteroviral vesicular stomatitis with exanthem), which is the diagnosis code for HFMD. Make note: When 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: Lindsey Bush, BA, MA, CPC, Production Editor, AAPC
