This week's post comes from National Compliance and Quality Audit Manager, Sharon Nichols, BSBEB, RHIT, CCS, CHTS-TR.
To continue our series on back to school bugs, this week’s information is related to those upset tummies and runny noses. What crosses your mind when a text message or note comes home from school stating over 100 students were sent home after lunch today? Could it be the dreaded pink slime or some other mystery meat on the menu? The school system can be a veritable zoo, and when the rhinos break out, we should all be on virus alert. As notes start coming home from school informing parents to keep children away if they are running a fever or vomiting, we will start to see more visits in the office or ER setting for the symptoms of enterovirus and rhinovirus. Today, we’ll answer some pesky virus questions and more.
At this point, you may be asking yourself, aren’t these viruses the same thing and don’t they cause the same problems? Well, although they are from the same picornavirus genome, they are not the same phenotype. As the blank stare sets in…Human Rhinoviruses and Enteroviruses are the leading cause of infection in humans per the CDC. Rhinovirus is not some big one or two-horned grassland creature, it is an adenovirus restricted to the respiratory tract causing what is also known as the common cold. Enteroviruses are typically restricted to the gastrointestinal tract but can affect other body systems causing a host of problems. We won’t go into the specifics of all the different conditions or types for these viruses, but drill down the distinct differences between the two.
A Rhinovirus is an adenovirus causing upper and sometimes lower respiratory infections. The incubation period is 12-72 hours and the infection typically lasts 7-11 days or longer. The throat becomes irritated or sore from nasal discharge with congestion and sneezing intensifying over 2-3 days’ time along with other ‘common cold’ symptoms. Believe it or not, your little darlings can give this lovely virus to you and younger siblings all with some variety in symptoms. Infants and preschoolers are more likely to present with a fever, toddlers may only have nasal discharge, and the rest of us usually complain of multiple symptoms in the respiratory tract. These infections typically occur in the fall and spring but can occur anytime of the year.
- Physical exam in addition to the above may show a very runny red nose, with clear or multi-colored nasal discharge. Reading through the exam note, one may see the physician has indicated glistening or glassy appearing mucous membranes without redness or swelling and the lymph nodes of the neck (cervical) or under the chin may be swollen.
- Complications can be numerous ranging from conjunctivitis to otitis media and may trigger an acute exacerbation of Asthma or other respiratory conditions.
- Treatment typically includes rest, fluids, symptom management and that reminder to always wash hands and cough or sneeze into the left elbow to prevent the spread of disease when you don’t have a tissue and always use hand sanitizer.
- Why the left elbow? Believe it or not, most people are right-handed, so sneezing or coughing into the left elbow helps reduce the spread of germs by reducing contact area.
For the general population, an enterovirus infection is one of more than 100 non-polio enteroviruses and can have little or no symptoms and do not cause illness. Where children are concerned, the symptoms can be nonexistent or cause both gastrointestinal and respiratory conditions due to immature immune systems and is similar to flu symptoms.
- Enteroviruses typically enter the body through the gastrointestinal tract but can also be found in the respiratory tract
- Infection typically occurs in the summer and fall but can occur any time of year
- The poliovirus vaccine is the only current vaccine for enteroviruses, these vaccines do not prevent non-polio enterovirus infection
- This highly contagious virus can be contracted through secretions from an infected individual, touching contaminated surfaces or objects and even diaper changes.
Coding – Both Rhinovirus and Enterovirus are coded in the B34 series of codes.
- When they cause another condition, they are coded as a secondary code from the B97 series with the appropriate disease listed first
- When they complicate pregnancy, they are coded as a secondary code from the B34 series with the appropriate Obstetric code listed first
- Let’s don’t forget, guidelines tell us the physician has to document it is not complicating the pregnancy to be coded as such
- Documented drug resistance is coded separately with a code from the Z16 series of codes
Case Study #1 – 10-year-old patient presents with sore throat, runny nose, headache and cough. Mom brought the child in because he is starting to lose his voice. After exam, physician recommends increased fluid intake, gargle with hot salt water, antihistamine every 6 hours for symptoms and rest. Final diagnosis; Pharyngitis due to rhinovirus.
- We know rhinovirus is an adenovirus and the cause of the patient’s pharyngitis in this case
- J02.8 Acute pharyngitis due to other specified organisms
- B97.0 Adenovirus as the cause of diseases classified elsewhere
Case Study #2 – 7 year old patient presents with nausea, vomiting, diarrhea and low grade fever. Final diagnosis by pediatrician is enteroviral gastroenteritis.
- All of the above symptoms are inclusive components of the enterovirus and are not coded separately
- A08.2 Adenoviral enteritis would be coded for this case