Pediatric ICD-10-CM Coding Tip Sheet

Overview of Key Chapter Updates for Pediatric and Top 25 codes

Chapter 5 - Mental, Behavioral and Neurodevelopmental Disorders (F00-F99)

Key Updates
 Classification improvements (different categories)
 Code expansions:
– Most notably, Other Isolated or Specific Phobias
 Updates to medical terminology:
– Bipolar I disorder, single manic episode will change to manic episode.
– Undersocialized conduct disorders, aggressive will become Conduct disorder
childhood-onset type.
 Nicotine dependence updated to identify specific tobacco products (cigarettes, chewing
tobacco, and other tobacco).

Chapter 7 - Diseases of the Eye and Adnexa (H00-H59)

Key Updates
 Diseases of the Eye and Adnexa is a new chapter in ICD-10-CM which has been separated
from the Nervous System and Sense Organs chapter included in ICD-9-CM.
 Terminology improvements (bringing terms up to date)
 Revisions to identify laterality:
– Many of the codes have laterality designation and, in some instances bilateral
designation for diseases of the eye.
– A code for unspecified site is also provided should the site not be identified in the
medical record.

Chapter 10 - Diseases of the Respiratory System (J00-J99)

Key Updates
 Modifications have been made to specific categories that bring the terminology up-to-date
with current medical practice.
– Emphysema now contains codes with panlobular and centrilobular in their
description.
– Asthma is now classified as mild intermittent, mild persistent, moderate persistent
and severe persistent.
 Specificity increased for diseases like influenza, acute bronchitis.
 Coding notes updated to require the coder to include information about tobacco
use/dependence, where applicable.
 Procedural complications that affect the respiratory system are now included in this chapter
in ICD-10-CM.

Chapter 18 - Symptoms, Signs and Abnormal Clinical and Laboratory Findings (R00-R99)
Key Updates
 Repeated falls are coded to a symptom code in ICD-10-CM (was a V code in ICD-9-CM).
 There are codes to identify a patient’s coma scale.
 Systemic inflammatory response syndrome (SIRS) due to noninfectious process is moved
from the Injury and Poisoning ICD-9-CM chapter to this ICD-10-CM chapter.
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Chapter 21 - Factors Influencing Health Status and Contact with Health Services (Z00-
Z99)
Key Updates
 These codes are used in any healthcare setting. Z codes may be used as either a first-
listed or principal diagnosis code in the inpatient setting, or secondary code, depending on
the circumstances of the encounter. Certain Z codes may only be used as first- listed or
principal diagnosis in certain situations. Refer to Official Coding Guidelines for details.
 Z codes are not procedure codes. A corresponding procedure code must accompany a Z
code to describe any procedure performed.

(Source: 2015 Draft ICD-10-CM Official Guidelines for Coding and Reporting)

The top 25 codes for Pediatrics in ICD-9 to ICD-10 mappings are found in the chart below.
ICD-9 ICD-10
Top 25 Code ICD-9 Description Code ICD-10 Description
Routine infant or child health Encounter for routine child health
1 V20.2
check Z00.121 examination with abnormal findings
Encounter for routine child health
Z00.129 examination without abnormal findings
Need for prophylactic
2 V04.81 vaccination and inoculation
against influenza Z23 Encounter for immunization
Need for prophylactic
3 V04.89 vaccination and inoculation
against other viral disease Z23 Encounter for immunization
Need for other prophylactic
4 V05.3 vaccination and inoculation
against viral hepatitis Z23 Encounter for immunization
Acute pharyngitis due to other specified
5 462
Acute pharyngitis J02.8 organisms
J02.9 Acute pharyngitis, unspecified
Need for prophylactic
vaccination and inoculation
6 V06.1 against diphtheria-tetanis-
pertussis, combined [DTP],
[DTaP] Z23 Encounter for immunization
Need for prophylactic
vaccination and inoculation
7 V03.82
against streptococcus
pneumonia [pneumococcus] Z23 Encounter for immunization
Need for prophylactic
vaccination and inoculation
8 V06.8
against other combinations of
diseases Z23 Encounter for immunization
Acute upper respiratory Acute upper respiratory infection,
9 465.9
infection of unspecified site J06.9 unspecified
Need for prophylactic
10 V03.89
vaccination, other specified Z23 Encounter for immunization
Other specified vaccinations
11 V03.81 against hemophilus influenza,
type B [Hib] Z23 Encounter for immunization
12 382.9 Unspecified otitis media H66.90 Otitis media unspecified, unspecified ear
H66.91 Otitis media unspecified, right ear
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 ICD-9 ICD-10
Top 25 Code ICD-9 Description Code ICD-10 Description
H66.92 Otitis media unspecified, left ear
H66.93 Otitis media, unspecified, bilateral
Need for prophylactic
vaccination and inoculation
13 V06.4
against measles-mumps-
rubella [MMR] Z23 Encounter for immunization
14 034.0 Streptococcal sore throat J02.0 Streptococcal pharyngitis
J03.00 Acute streptococcal tonsillitis,unspecified
J03.01 Acute recurrent streptococcal tonsillitis
Need for prophylactic
15 V05.4 vaccination and inoculation
against varicella Z23 Encounter for immunization
Routine general medical
16 V70.0 examination at a health care Encounter for general adult medical
facility Z00.00 examination without abnormal findings
Encounter for general adult medical
Z00.01 examination with abnormal findings
17 461.9 Acute sinusitis,unspecified J01.90 Acute sinusitis, unspecified
J01.91 Acute recurrent sinusitis, unspecified
Acute suppurative otitis media
18 382.00 without spontaneous rupture of Acute suppurative otitis media without
ear drum H66.001 spontaneous rupture of ear drum, right ear
Acute suppurative otitis media without
H66.002 spontaneous rupture of ear drum, left ear
Acute suppurative otitis media without
H66.003 spontaneous rupture of ear drum, bilateral
Acute suppurative otitis media without
spontaneous rupture of ear drum, recurrent,
H66.004 right ear
Acute suppurative otitis media without
spontaneous rupture of ear drum, recurrent,
H66.005 left ear
Acute suppurative otitis media without
spontaneous rupture of ear drum, recurrent,
H66.006 bilateral
Acute suppurative otitis media without
spontaneous rupture of ear drum, recurrent,
H66.007 unspecified ear
Acute suppurative otitis media without
spontaneous rupture of ear drum,
H66.009 unspecified ear
19 780.60 Fever, unspecified R50.2 Drug induced fever
R50.9 Fever, unspecified
20 786.2 Cough R05 Cough
Attention deficit disorder of Attention-deficit hyperactivity disorder,
21
314.01 childhood with hyperactivity F90.1 predominantly hyperactive type
Attention-deficit hyperactivity disorder,
F90.2 combined type
Attention-deficit hyperactivity disorder, other
F90.8 type

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 ICD-9 ICD-10
Top 25 Code ICD-9 Description Code ICD-10 Description
Attention-deficit hyperactivity disorder,
F90.9 unspecified type
Single live born, born in hospital
22 V30.00 delivered w/o Cesarean section Z38.00 Single liveborn infant, delivered vaginally
Single liveborn infant, unspecified as to
ZZ38.2 place of birth
Need for prophylactic
vaccination and inoculation
23 V06.3 against diphtheria-tetanus-
pertussis w/poliomyelitis[DTP
+ polio] Z23 Encounter for immunization
24 493.90 Asthma, unspecified J45.909 Unspecified asthma, uncomplicated
J45.998 Other asthma
Need for prophylactic
25 V04.0 vaccination and inoculation
against poliomyelitis Z23 Encounter for immunization

The codes highlighted in orange indicate the individual ICD-9 code that is being mapped
to one or many ICD-10 codes
(Source of ICD-9-CM to ICD-10-CM mappings: CMS.org General Equivalence Mappings (GEMs), 2015)

The information in this document is not intended to impart legal advice. This overview is intended as an educational tool only and should not be relied
upon as legal or compliance advice. If you have any legal questions about the information contained herein, you should consult your attorney or other
professional legal services provider.