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How to put new ICD-10-CM codes into practice :

August 18, 2016

Coming Oct. 1, the health care industry will see the largest update to the International Classification of Diseases code set outside of the transition to ICD-10-CM due to the five-year code freeze.

It is important to review the updated addenda to ensure you have all the code changes. Most of the pediatric updates were presented in the July and August Coding Corner columns.

Following are some examples of how to use a few of the new codes.

Updates to perinatal coding issues

A 12-day-old patient presents to the pediatric office. The mom made the appointment because she is convinced the baby has stopped breathing from time to time. After taking the history, performing the exam and witnessing what the mom thought was an apneic spell, the physician determines the baby is fine. He counsels the mom on what to look for and reassures her that what she was seeing is normal.

Report code Z05.3 Observation and evaluation of newborn for suspected respiratory condition ruled out. This is a new category of codes that can be used in the neonatal period to define encounters when the condition thought to be present is ruled out.

A baby is born at term gestation to a mother with suspected chorioamnionitis who was febrile during labor. The baby is asymptomatic and has a blood culture performed along with complete blood count and differential. Broad spectrum antibiotics are initiated pending lab results. After 48 hours of negative blood culture, the baby's antibiotics are discontinued.

Report the following codes for each day:

Day 1 P02.7 Newborn affected by chorioamnionitis

Day 2 P02.7 Newborn affected by chorioamnionitis

Day 3 Z05.1 Observation and evaluation of newborn for suspected infectious condition ruled out

If you plan to code or bill only on the day of discharge, report Z05.1.

Other medical issues

A 4-year-old patient presents to the office with facial swelling near the left eye. The physician examines the patient and determines he has periorbital cellulitis. Due to severity of this condition, the physician decides to admit the child for antibiotic therapy.

Report code L03.213 Periorbital cellulitis. This new code was added because the current code set did not have a specific code for the severity of this condition.

A 6-week-old presents for the first time to the office. Upon exam, a sacral dimple is noted, and the physician documents this for possible follow-up services.

Report code Q82.6 Congenital sacral dimple.


A young patient was seen in her primary care office for a school entrance exam. A vision screen was performed, and the result was abnormal. The pediatrician suspects amblyopia, so he refers the patient to a pediatric ophthalmologist. During the encounter, the pediatric ophthalmologist also suspects amblyopia. The young child is unable to read a chart but has refractive, strabismic or eye structural problems of the right eye that often are associated with amblyopia. The physician is concerned that the child has significant factors for amblyopia and wants to ensure proper follow-up. The physician diagnoses “amblyopia, suspect, right eye” and uses code H53.041 Amblyopia suspect, right eye.

This new code set is important because per ICD-10-CM guidelines, “suspected” conditions cannot be reported in the outpatient setting as if they existed for the patient. Because of the wording of the code, the physician can use this code to track a patient who is suspected of this condition. The unique code serves as a reminder so the child receives ongoing medical observation and timely intervention when required. Both the pediatrician and the pediatric ophthalmologist may report this code.

Encounter for codes:

A patient presents and needs fluoride varnish application.

Report Z29.3 Encounter for prophylactic fluoride administration.

A patient presents for respiratory syncytial virus injection.

Report Z29.11 Encounter for prophylactic immunotherapy for respiratory syncytial virus (RSV).

A patient presents for malaria pills for an upcoming trip.

Report Z29.8 Encounter for other specified prophylactic measures.

Note: In all the “encounter for” examples, additional ICD-10-CM codes may be needed to define the entire encounter.

Becky Dolan, in the AAP Division of Health Care Finance, contributed to this report.

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