September 15, 2014

Coding Current Events

By Kathy Pride, CPC, RHIT, CCS-P

Recent news of the Enterovirus 68 is spreading as fast as the virus! In the past few weeks thousands of children have been treated in hospitals across the country. The Centers for Disease Control and Prevention (CDC) is watching this situation closely and helping states test specimens. When the news broke about this virus, my first thought was “I wonder what the ICD-10 code for Enterovirus 68 is?” With the increased specificity of ICD-10, I was sure there would be a new, very specific code.

Not really knowing exactly what Enterovirus 68 was, I started by checking the ICD-10 index. I was surprised to find that there was only a non-specific code for a virus with such a specific name. After all, this wasn’t just an enterovirus, it was Enterovirus 68. So I decided to do some research, which turned up some surprising findings.

First of all, Enterovirus 68 is actually not a new virus at all. It was, however, until now, very rare. So what is Enterovirus 68, also known as EV-D68? EV-D68 was first identified in California in 1962. According to the CDC, enterovirus is the title used to denote a group of more than 100 of the most common viruses that affect humans and other mammals. Most people encounter an enterovirus by way of the common cold, which can be caused by enteroviruses as well as rhinoviruses. Enterovirus 68 got its number because it was the 68thenterovirus to be identified. Perhaps the reason there is not a specific code for the enterovirus is because they would need more than 100 codes to cover them all.

Since the discovery of EV-D68 in 1962 through 2005, there were only 26 confirmed reports of the virus to the CDC. Experts say they do not know why it has flared up since 2005. The virus can start just as a common cold. Though enteroviruses are associated with various clinical symptoms, including coughing (R05), difficulty breathing (R06.00), and in some cases, a rash (R21), EV-D68 primarily causes respiratory illness (although the full spectrum of the disease remains unclear at this time). EV-D68 can also lead to severe respiratory symptoms like wheezing (R06.2). Health officials warn that young children and people with asthma may be particularly vulnerable. This virus can turn a simple asthma into a severe persistent asthma with an acute exacerbation.

According to the CDC, the virus spreads like the common cold, via coughing, sneezing, or people touching other people or things infected with the virus. There is no treatment that is specific to the virus; there are no anti-viral medications or vaccines to prevent you from catching it. The good news is that the CDC reports that most cases of the EV-D68 virus are not fatal. Intensive treatment and supportive care, including oxygen provided in a hospital environment, help treat it. The average length of a hospital stay of patients ranged from 1.5–5 days.

In a report released by the CDC on Sept. 12, 2014, the reported cases associated with this recent outbreak appear to involve children ranging from the ages of 6 weeks to 16 years old, with a median age of 4. So why is this virus affecting more children than adults? Experts do not really know. This is a mystery that they hope to solve in the near future with continued research. 

The code for the EV-D68 is a non-specific code in both ICD-9 (008.67 – Enterovirus NEC) and ICD-10 (B97.19 – Other enterovirus as the cause of diseases classified elsewhere). So if we are reporting non-specific codes on our claims, how did the CDC learn of the outbreak clusters of such a specific virus? Enterovirus infections, including EV-D68, are not mandatorily reportable, but laboratory detections of enterovirus and parechovirus types are reported voluntarily to the National Enterovirus Surveillance System, which is managed by the CDC. Participating laboratories are encouraged to report monthly summaries of virus type, specimen type, and collection date. In a recent report on a local Denver news broadcast, more than 400 children were treated for symptoms at a Denver children’s hospital this past week, with approximately 75 percent testing positive for the virus. News of this nature is sure to get the attention of the epidemiologists at the CDC.

So what can we do to prevent this virus from spreading further? The prevention tips from the CDC are not only simple; they are things we should be practicing every day. Wash your hands with soap and water regularly. Clean and disinfect surfaces that are regularly touched by different people. Avoid sick people. If you or your kids are sick, stay home. Keep asthma under control; stay on asthma medications. Get the flu vaccine as soon as it is available and make sure that everyone in your family is vaccinated against pertussis (whooping cough).

About the Author

Kathy Pride, CPC, RHIT, CCS-P, is vice president of professional services for Panacea Healthcare Solutions. Kathy has extensive experience in management, project implementation, coding, billing, physician documentation improvement, compliance audits and education. She is also an approved ICD-10 Trainer through the American Health Information Management Association (AHIMA) and a previous member of the AAPC National Advisory Board (1998 – 2000).

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