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Pediatric Coding Alert

Reader Questions:

Coding Negative Strep Test Forces You to Rely on Symptoms

Published on Fri May 06, 2011

Question:Which diagnosis codes should we report for a strep test that comes out negative if the patient didn't have pharyngitis, scarlet fever, or tonsillitis? We performed the test because the patient had vomiting, rash, and headache and we got a denial. Any suggestions?Georgia SubscriberAnswer:The physician should write a letter appealing the claim and noting that based on his clinical diagnosis, the patient exhibited other symptoms of strep besides pharyngitis and scarlet fever. For instance, the combination of headache (784.0), abdominal pain (789.00), and vomiting (787.03) led the physician to believe that the patient may have been experiencing strep throat. If the patient mentioned exposure to strep at school or at home, the physician should mention that in his letter, and you should report the appropriate V code for it (for instance, V01.89, Contact with or exposure to other communicable diseases).
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