Pediatrics coders have a whole host of ICD-10-CM coding changes to learn by October 1, 2018, and you’re probably focusing quite a bit on the 25 new codes describing newborn complications in Chapter 16. But while you’re getting up to speed on those changes, don’t overlook the equally important new and revised Z codes in Chapter 21.
ICD-10 Z codes can be payable or informational, but what they definitely are is essential, says pediatrics coding expert Donelle Holle in her ProfEdOnDemand webinar, “2019 ICD-10-CM Update: Code Changes for Pediatrics.” You now have a variety of coding choices to describe developmental delay types, mental health and behavioral disorder screenings, and much more.
Use New Codes for Exam Encounters
Heads up: There are more than 200 changes in the 2019 ICD-10 updates that will impact pediatrics, and a good portion of those changes are to Z codes in Chapter 21 (Factors Influencing Health Status and Contact with Health Services), according to the American Academy of Pediatrics.
First: For Z00.12 — Encounter for routine child health examination, the Centers for Medicare & Medicaid Services (CMS) deleted the note “encounter for development testing of infant or child,” and then replaced it with:
- Immunizations appropriate for age;
- Routine developmental screening of infant or child; and
- Routine vision and hearing testing.
Important: The subcategories for general medical examinations (Z00.0-) and routine child health examinations (Z00.12-) provide codes for encounters with and without abnormal findings, according to the 2019 ICD-10 guidelines. If an exam results in an abnormal finding, make sure you assign the code for general medical examination with abnormal finding as the first-listed diagnosis.
More: Under Z04.8 — Encounter for examination and observation for other specified reasons, CMS added the following new codes:
- 81 — Encounter for examination and observation of victim following forced sexual exploitation
- 82 — …following forced labor exploitation
- 89 — …for other specified reasons
Use Code Set Z13 for Mental & Behavioral Health Screenings
In addition to new codes for reporting forced labor and sexual exploitation, you also have multiple new ICD-10 codes for various screenings, noted a blog posting by Kent Moore, Senior Strategist for Physician Payment at the American Academy for Family Physicians (AAFP).
Under Z13 — Encounter for screening for other diseases and disorders, CMS added these new codes:
- 3 — Encounter for screening examination for mental health and behavioral disorders
- 30 — Encounter for screening examination for mental health and behavioral disorders, unspecified
- 31 — Encounter screening for depression
- Encounter screening for depression, adult
- Encounter screening for depression, child or adolescent
- 32 — Encounter screening for maternal depression
- Encounter screening for perinatal depression
- 39 — Encounter screening examination for other mental health and behavioral disorders
- Encounter screening for alcoholism
- Encounter screening for intellectual disabilities
Don’t overlook: Under Z13.4 — Encounter screening for certain developmental disorders in childhood, CMS added the note “encounter for development testing of infant or child.” CMS deleted the note “Excludes 1: routine development testing of infant or child (Z00.1-)” and replaced it with “Excludes 2: encounter for routine child health examination (Z00.12-).”
Also under Z13.4, CMS added the following new codes:
- 41 — Encounter for autism screening
- 42 — Encounter for screening for global developmental delays (milestones)
- Encounter for screening for developmental handicaps in early childhood
- 49 — Encounter for screening for other developmental delays
Report Z20.821 for Zika Virus Exposure
Finally, you have a new code for Zika virus: Z20.821 — Contact with and (suspected) exposure to Zika virus.
One more: Also, under Z28.8 — Immunization not carried out for other reason, CMS added:
- 83 — Immunization not carried out due to unavailability of vaccine
- Delay in delivery of vaccine
- Lack of availability of vaccine
- Manufacturer delay of vaccine
Bottom line: Make sure you learn the proper coding conventions for all the new and revised diagnosis codes that will affect the diagnoses you regularly see in pediatric offices, Holle stresses. Accurate ICD-10 coding for newborns and up will help you avoid claims denials and payment delays, while capturing the full patient story.