ICD-10 essentials for busy pediatricians who would rather be doing something else -- bronchiolitis, asthma, otitis media


This is my only chance to talk about the changes in ICD-10 for diagnosis codes that might be of interest to pediatricians. It is a pretty tall order for a specialty that covers the whole human body, one that just happens to be on the young side. I hope I chose well. I had some help.

Bronchiolitis
Nothing here that would make page one of the Wall Street Journal. There are two acute bronchiolitis codes that specify the responsible organism:  RSV or human metapneumovirus. ICD-9 has an RSV code but no code specifying human metapneumovirus. (ICD-10 has unique RSV codes for pneumonia and acute bronchitis as well.) The acute bronchiolitis codes are shown below.

J21.0 Acute bronchiolitis due to respiratory syncytial virus 

Replaces
466.11 Acute bronchiolitis due to respiratory syncytial virus (RSV) 

J21.1 Acute bronchiolitis due to human metapneumovirus
J21.8 Acute bronchiolitis due to other specified organisms
J21.9 Acute bronchiolitis, unspecified

Replace
466.19 Acute bronchiolitis due to other infectious organisms  

Asthma
Asthma coding has changed a good bit. I covered this topic in some detail in a previous blog. Briefly the changes are that the codes that categorize asthma as intrinsic or extrinsic have been discontinued. Two more practical levels of detail have been added in ICD-10 — hopefully more useful, therefore more likely to be documented and coded. 

  • Asthma in ICD-10 is categorized by degree of severity — mild, moderate and severe are the terms used in the codes to distinguish the level of severity.
  • Asthma in ICD-10 is further categorized as either intermittent or persistent. You do not need to know the precise trigger to use these codes.

Otitis media
With otitis media we hit paydirt in ICD-10. Two additional levels of detail create a lot of new codes, but they also allow you to say stuff efficiently about your patient that is reasonably important to know, namely:

  • Whether the infection is in the right ear, the left ear, or both ears.
  • That incidence of a specific type of acute otitis media is recurrent.

Yes, I know, left or right won’t pay any differently, but the information is there and other people want to track patterns of infection over time in a whole population, even if you don’t personally thrive on that kind of thing.

ICD-10 codes for suppurative otitis media don’t require you to specify the cause, but check this out: If you document that your patient is exposed to significant secondary tobacco smoke, this little jewel of a code can be added to the patient record. P96.81 Exposure to (parental) (environmental) tobacco smoke in the perinatal period.  It is provided as a “use additional code” suggestion right there in the notes of the ICD-10 book. Who knows, maybe you can get a parent to stop smoking by contriving to have them see this rather official-looking code on their child’s medical record.

The new acute suppurative otitis media codes are shown below with the ICD-9 codes they replace. Highlight has been added so you can see the differences at a glance. Each of these options is repeated “with spontaneous rupture of ear drum” as a unique code, so a total of 16 codes are available for this condition.

H66.001 Acute suppurative otitis media without spontaneous rupture of ear drum, right ear 
H66.002 Acute suppurative otitis media without spontaneous rupture of ear drum, left ear 
H66.003 Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral 
H66.004 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear 
H66.005 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear 
H66.006 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral 
H66.007 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear 
H66.009 Acute suppurative otitis media without spontaneous rupture of ear drum, unspecified ear 

Replace
382.00 Acute suppurative otitis media without spontaneous rupture of eardrum

All the other terminology used to describe the acute and chronic subtypes is the same as in ICD-9, with one exception: allergic acute otitis media is its own subtype in ICD-10. The types are summarized below.

• Acute

o Nonsuppurative

• Allergic
• Serous
• Mucoid
• Sanguinous
• Other/unspecified

o Suppurative

• With spontaneous rupture of tympanic membrane
• Without spontaneous rupture of tympanic membrane/unspecified
• Chronic

o Nonsuppurative

• Serous
• Mucoid
• Sanguinous
• Other/unspecified

o Suppurative

• Tubotympanic suppurative
• Atticoantral suppurative
• Other/unspecified

And if after all my preaching you still want to treat a code as nothing more than a SKU, ICD-10 will not take it personally. ICD-10 will “work with you.”  Here are the codes for unspecified otitis media.

H66.90 Otitis media, unspecified, unspecified ear 
H66.91 Otitis media, unspecified, right ear 
H66.92 Otitis media, unspecified, left ear 
H66.93 Otitis media, unspecified, bilateral 

Replace
382.9 Unspecified otitis media

Meanwhile, a heads up on the Neoplasm chapter codes — much is the same, but those amazingly detailed systemic cancer codes are proliferating like — well, cancer. I’ll do my best to say something useful about them in the space of an upcoming blog.

Rhonda Butler is a senior clinical research analyst with 3M Health Information Systems. She is responsible for the development and maintenance of the ICD-10 Procedure Coding System since 2003 under contract to CMS, and for the development and maintenance of the ICD-10 General Equivalence Mappings (GEMs) and Reimbursement Mappings under contract to CMS and the CDC.  She leads the 3M test project to convert the MS-DRGs to ICD-10 for CMS, and is on the team to convert 3M APR-DRGs to ICD-10. Rhonda also writes for the 3M Health Information Systems blog.