Pediatric Coding Alert

ICD-9 2008 brings changes for 2 herpesvirus infections, recognizes infant botulism

When new ICD-9 codes go into effect this fall, correct coding mandates that you update your superbill with new codes for roseola, Parvovirus and infant botulism.

The Centers for Disease Control & Prevention released the new ICD-9 codes for 2008. They take effect Oct. 1, with no grace period.

Some more codes may be added to the list between now and September, but most of 2008's new additions are already available. Although the 146 new codes for this fall contain relatively few changes for pediatrics, Pediatric Coding Alert zooms in on the roster of disease code changes most important to you. Default to 058.10 Unless This Occurs Starting Oct. 1, if you relegate "roseola infantum" to an "other specified" code (057.8, Other specified viral exanthemata), you won't be designating this virus correctly. ICD-9 2008 will debut a new subcategory series (058) for "other human herpesvirus" (HHV).

Eight new codes will identify the herpesvirus based on type and associated clinical condition. You'll use one of three codes (058.10-058.12) for roseola infantum. ICD-9 2008 will let you identify the virus that caused the infection with one of three fifth-digit subclassifications:

• Assign 058.10 "roseola infantum, unspecified" when the medical record doesn't identify the virus type. Expect to default to the unspecified code more often than not. "We will likely use 058.10 if we diagnose roseola, because usually it is a clinical and not a laboratory diagnosis," says Jennifer G. Brinton, MD, FAAP, pediatrician at Utah Valley Pediatrics in Orem. There is no way to tell the viruses apart just from the clinical exam.

• Report 058.11 for "roseola infantum due to human herpesvirus 6." "Primary infection with HHV-6B causes roseola infantum or exanthem subitum, a common childhood exanthema," according to AHIMA's "Summary of March 2006 ICD-9-CM Coordination and Maintenance Committee Meeting."

• Use 058.12 for "roseola infantum due to human herpesvirus 7." "Human herpesvirus 7 (HHV-7) is another beta herpesvirus that causes roseola infantum in infants," state the ICD-9 C&M Committee notes.

Impact: To code for the specific virus, you'd have to have a positive lab result for HHV6 or HHV7--a test your office does not order. Infectious disease (ID) specialists have recommended testing for specific HHV6 or HHV7 only "when we've had an infant with a prolonged fever in whom we could not clinically diagnose roseola," Brinton says.

Thirty percent of children with roseola do not have the classic rash, making clinical diagnosis virtually impossible, according to one ID specialist.

Don't fret about using an unspecified code in these cases. "Unless you are billing a procedure on a specific body area that requires a specific matching diagnosis," the ICD-9 code shouldn't affect payment, says Susan Callaway, CPC, CCS-P, an independent [...]