This week's post comes from National Compliance and Quality Audit Manager, Sharon Nichols, BSBEB, RHIT, CCS, CHTS-TR.
It’s the most wonderful time of the year! That’s right, it’s back to school for the kiddos. As the hustle and bustle of the new school year starts and the morning drive (flashing red, school bus ahead) slows to the pace of a horse and carriage ride, our children will soon be sharing more than summer vacation stories with their friends. As parents, teachers and school administrators deal with runny noses, sneezing and coughing (into the left elbow please) we in the healthcare industry will be tasked with applying the ever interesting and complicated codes associated with all those bugs.
Bugs come in all shapes and sizes; bacteria, viruses, and yes, my friends, even bugs. Head lice, for one, is an elementary school nightmare and very hard to stamp out with so many children in close quarters. Our focus in this three-part series will be on the most common bugs our little darlings in grade school like to share the first few weeks of school. First, we’ll discuss type and transmission of conjunctivitis… what a lovely pink eye you have. Then we’ll discuss Rhino vs. Entero viruses…doesn’t a rhino live in the zoo? And finally, when your six-year-old excitedly tells you that he has “the head lights” it doesn’t mean he took them from the car, it’s our favorite little creepy critter head lice. Now that your eyes are itching, you’re wheezing, your tummy is upset and your skin is crawling, let’s get a little more comfortable with our knowledge and coding.
We won’t go into the many differences between bacteria and viruses or the various bugs we studied in school, but the distinct components of Pink Eye in this first part of our series.
The conjunctiva is the membrane lining the eyelids and covering the eyeball, irritation and infection can be referred to as ‘Pink eye’. Pink eye can be caused by viruses such as adenovirus, bacteria such as Staph or Strep, allergens like pollen and dust, or irritants like chemicals and contact lenses. Pink Eye is an acute form of conjunctivitis described as mucopurulent meaning there is a purulent discharge from the eye. Pink Eye falls into one of two ICD-10-CM categories from Chapter 7. Diseases of the eye and adnexa; Acute Follicular or Other Mucopurulent conjunctivitis. When it’s due to a bacteria or virus specified in the Infectious Disease chapter, the code would come from that chapter instead.
Mild cases of pink eye usually resolve on their own, but there are key indicators that medical treatment is necessary. When pain in the eye becomes moderate to severe and light sensitivity exists, or that cotton candy pink tone to the whites of the eye(s) turns an angry red, medical treatment is needed. So, we know what causes Pink Eye, but how do we code such a colorful condition? Coding is dependent upon the cause or source of the conjunctivitis and the laterality.
- Follicular conjunctivitis is determined by macroscopic or microscopic appearance of small, dome-shaped follicles without a prominent central vessel and can be seen with inflammation caused by pathogens, toxins and medications. This condition is coded in the H10.01 – H10.02 series of codes.
- This should not be mistaken for Papillary conjunctivitis which shows a cobblestone appearance with a central vessel, typically caused by an allergic response or foreign object such as a contact lens.
- Due to exposure means keratoconjunctivitis wherein the conjunctiva and cornea are affected, this can be seen in cases where the patient is exposed to chemicals or other irritants and is coded from the H16.21 series of codes. This is not ‘Pink Eye’ in the form caused by patient to patient transmission.
Case Study – A patient presents with pain in the left eye with itching and drainage after being around his niece who has pink eye. The physician examines the eyes and notes drainage, irritation, redness and pain without involvement of the cornea in the left eye. The right eye is clear of symptoms and the final diagnosis pink eye on the left.
- Pink Eye is defined as acute mucopurulent conjunctivitis, other/unspecified unless the physician indicates a specific type or cause. H10.002
- Symptoms are not coded separately as they are inherent to the disease process