H04.533 vs. Q10.5?

kmdnine

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I changed H04.533 to Q10.5 on a 2 month old child, and got nailed on it from our auditing team. They are citing chapter 16 guidelines. My contention is that these guidelines are chapter specific, and don't apply to codes in chapter 7. I also cited the color coded "N" to the right of the H code, indicating the age specific dx. Who's right?
 
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I changed H04.533 to Q10.5 on a 2 month old child, and got nailed on it from our auditing team. They are citing chapter 16 guidelines. My contention is that these guidelines are chapter specific, and don't apply to codes in chapter 7. I also cited the color coded "N" to the right of the H code, indicating the age specific dx. Who's right?

Assuming this condition isn't something new, in my opinion, H04.533 would be accurate. Reason being, the guidelines for chapter 16 state "Should a condition originate in the perinatal period, and continue throughout the life of the patient, the perinatal code should continue to be used regardless of the patient’s age." Although the guidelines are attached to chapter 16, in these circumstances, the guidelines would encompass other chapters as well. Yes, H04.533 has the "N" symbol, but the guidelines trump it in the end. Sorry :(
 

kmdnine

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Thanks

Thanks for taking the time to respond.

My main problem was that I had issues with the terms "chapter 16 specific", and "chapter 16 codes..." that were everywhere in those guidelines.

I requested an opinon from our regional coding council, to see what their opinion was. Their response was that it will get rejected if I use H04.533 due to the age/code discrepancy. They maintain that after 28 days, it becomes P96.89 + Q10.5, and Chapter 16 guidelines then apply.

Kind of makes sense.
 

mitchellde

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H04.53- codes are by definition:
The blockage of the nasal tear-draining duct that specifically develops after birth and is not due to a fetal distortion of the duct.
Q10.5 code is:
A condition/malformation present in the fetus prior to birth and may continue beyond infancy.
So the question really is did the problem originate in the fetus, or is this something that developed after birth.
 
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