Health Information Management

Q&A: Coding for shingles

JustCoding News: Inpatient, June 20, 2012

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QUESTION: A patient was exposed to shingles, for which a coder reported ICD-9-CM code V01.79 (exposure to other viral diseases, including HIV). This poses a problem for billing as code V01.79 is a confidential diagnosis, requiring special release of information from the patient and would remain on the insurance record. As an RN and certified coder, I believed code V01.71 (exposure to varicella) is the correct code because the varicella virus causes both chicken pox and shingles. However, I am being overridden by the chief business office. Which code is correct?

ANSWER: I understand where the confusion is coming from, for both the coder and the business office. When you look up “Shingles” in the ICD-9-CM Manual, it directs you to herpes zoster, which is not one of the modifying terms under the main term “exposure.” Therefore it would seem appropriate to use code V01.79.
 
It is interesting that certain viruses (e.g., smallpox and varicella) have specific codes, but other viruses fall under the not elsewhere classified (NEC) category, again making code V01.79 seem appropriate. It is also interesting that HIV does not have a specific code itself and is lumped in with viruses NEC.
 
Shingles are caused by herpes zoster, an infection that results when a varicella-zoster virus reactivates from its latent state in posterior dorsal ganglion, according to Merck. Both chicken pox and herpes zoster are caused by the varicella-zoster virus (herpes virus type 3). Chicken pox is considered an active phase of the virus whereas shingles (herpes zoster) is a latent phase of the virus (i.e., a reactivation of the virus). Therefore I agree that exposure to varicella, code V01.71, would be appropriate here.
 
That said, neither the alphabetic index nor the tabular list give guidance here and so it is understandable why there could be different viewpoints regarding the coding. Coding Clinic does not provide any advice on the subject either.
 
Unfortunately, we may not be able to provide a clear cut answer to this question. Both opinions seem logical and appropriate, and I can’t say for certain that one or the other is truly correct as herpes zoster does not have its own specific code and doesn’t cross-reference to varicella.
 
The only advice that I can offer is that you educate the business office staff and see if you can change their minds on this one, but, again, we really cannot say with 100% certainty that they are incorrect on this one.
 
Editor’s Note: Jennifer Avery, CCS, CPC-H, CPC, CPC-I, regulatory specialist for HCPro, Inc., in Danvers, Mass., answered the previous question.

This answer was provided based on limited information that was submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
 
Need expert coding advice? Submit your question to Senior Managing Editor Andrea Kraynak, CPC, at akraynak@hcpro.com, and we’ll do our best to get an answer for you.



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