Pediatric Obesity, Immunizations, and Child Abuse

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• Abstract
• Obesity
• Immunizations
• Child Abuse
• Copyright

ICD-9 codes generally are not specific to an age group, with few exceptions. The exceptions discussed in this month's column include obesity and body mass index codes, immunization codes, and child abuse codes.

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Obesity 

Childhood obesity is a growing epidemic. It is of great importance that correct diagnostic coding is implemented when addressing overweight and obese patients. New V-codes were incorporated in the ICD-9 Clinical Modification in 2007. These secondary codes, which specify body mass index (BMI), will allow providers to accurately identify obese and overweight children to effectively provide childhood obesity prevention and treatment services. BMI pediatric codes are for use for patients age 2- to 20-years-old. The percentiles are based on the growth charts published by the Centers for Disease Control and Prevention (CDC).

Primary ICD-9 diagnosis codes for overweight and obesity fall into the 278.0 category and are required to be coded to the 5th digit. Acceptable codes are:

Primary diagnosis codes should be supplemented with a secondary diagnosis code to identify BMI using the pediatric BMI V-codes:

The supplemental classification V-codes are:

V-codes V85.0 — V85.4 are BMI adult codes for use for persons over 20-years-old and are not to be used for secondary diagnosis for pediatric patients.

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Immunizations 

There are a total of 8 immunization administration CPT codes: 4 non-age–specific codes (90471-4) plus 4 pediatric-specific codes (90465-8). Their code descriptors are as follows:

The pediatric-specific codes have 2 requirements: (1) the patient must be under 8 years of age and (2) the physician (not the clinical staff) must perform face-to-face vaccine counseling associated with the administration. If both of these requirements are not met, report a code from the 90471-90474 code family instead. The pediatric-specific codes do not require that the physician to do the actual vaccine administration. The clinical staff may perform the actual vaccine administration. The pediatric-specific codes require that the physician perform face-to-face vaccine counseling in conjunction with the administration.

In October 2005, 10 new ICD-9 codes that allowed greater specificity in reporting the reason why a vaccination was not administered became effective.

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Child Abuse 

Codes for child abuse are included under Injury and Poisoning, V-codes, and E-codes. E codes for child and adult abuse take priority over all other E-codes. When the cause of an injury or neglect is intentional child or adult abuse, the first listed E-code should be assigned from categories E960-E968, Homicide and injury purposely inflicted by other persons (except category E967). An E-code from category E967, Child and adult battering and other maltreatment, should be added as an additional code to identify the perpetrator, if known.

There are concerns about labeling a child with suspected abuse until it has been proven. The code V71.81 Observation for suspected abuse and neglect, along with codes for specific injuries observed, may be used.

Revised from http://www.cispimmunize.org/pro/pdf/Attachment%20D_Overview.pdf and http://www.cdc.gov/nchs/datawh/ftpserv/ftpICD9/icdguide08.pdf.