January 25, 2016

ICD-10 and the Zika Virus: Another Public Health Crisis

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There have been several articles published recently about the latest public health crisis to attract the world’s attention: the Zika virus, which is currently spreading in South America, Central America, and the Caribbean.

This virus is a flavivirus that causes flulike symptoms in patients. An infected mosquito spreads the virus. The biggest risk the virus poses is its impact on pregnant women. There are some thoughts that the Zika virus may be related to the increase of microcephaly newborns in Brazil, where it has been flourishing. Newborns with microcephaly have unusually small heads.

How would the condition be coded under ICD-10-CM? The Index under the main term of “virus” does not have an entry for the Zika virus. The Index does not include options under “Zika” either. The code for other specified virus is B33.8 (Other specified viral diseases), but this lacks information indicating that the condition is mosquito-borne. This viral infection is similar to Dengue fever (A90), so in reviewing the options near this code, A92.8 (which is entitled “Other specified mosquito-borne viral fevers”), may be the best option. For those inpatient coders, this code is a CC in the MS-DRG methodology.

For pregnant women who have contracted the disease, what would the ICD-10-CM coding look like? There is an entry under “Pregnancy, complicated by viral disease” that yields O98.51- (Other viral diseases complicating pregnancy). The dash would be completed with the current trimester of the patient and would be the sixth character. Additionally, there are codes for the patient who delivers (O98.52) and for the woman who has had a baby but may need additional care (O98.53). In reviewing the tabular list for coding instructions, there is “Use additional code (Chapter 1) to identify specific infectious or parasitic diseases” instruction. Again, for the inpatient coders, this condition is a CC in the MS-DRG methodology.

For the newborn born with microcephaly, the condition would be coded as Q02. The Index term, microcephaly, has the default code of Q02. There are no instructional notes associated with this congenital code. Unlike the pregnancy and viral codes discussed earlier, this code, Q02, is not a CC in the MS-DRG methodology.

One thing to remember is that the U.S. is still under a partial code freeze, which means that there are no changes to the code set being made until October 2016. The exceptions to the partial code freeze are new emerging technologies, which include procedures that impact the MS-DRG methodology, or public health concerns such as the H1N1 virus in previous years. The Zika virus may become one of those public health concerns. If the Centers for Disease Control and Prevention (CDC) considers the Zika virus a significant public health concern, a new code may be created before the Oct. 1, 2016 date.

Stay tuned!

Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

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