Wiki Newborn age edit

[LUDS]

I'm not a pediatric coder and not really familiar with this. Our program integrity unit is questioning paying claims when a diagnosis with a "N" edit is submitted when the age of the patient is over 29 days. They state this edit indicates the age of the patient must be < 30 days old. Is that correct and if so, where is that documented? When I read the edit it sounds like it can be used as long as the patient is not a year old yet. Any help will be appreciated.

 

[erjones147]

Newborns are defined by ICD-9 as birth to 28 days old. Check out V20.2 and
V20.3 for two examples. What code is giving you the edit?

 

[LUDS]

767.6 is the code

 

[Cynthia Hughes]

It sounds like the Medicare Code Editor is being applied. The thing is that this conflicts with the HIPAA-mandated compliance with the official guidelines for reporting ICD-9-CM that allows reporting of codes like 767.6. The guidelines state, "Chapter 15 code may be used throughout the life of the patient if the condition is still present." For instance, AHA Coding Clinic advises to report preterm birth codes for children for as long as their physician documents that the condition continues to affect treatment and management.