AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2017 Issue 4; Ask the Editor

Pediatric vs. Adult Diagnosis Code

Is there any official guidance as to when a pediatric versus an adult diagnosis code may be used? We are getting many rejections/denials, as there appear to be different ages for edits. Within my ICD-10-CM book, code Z00.121, Encounter for routine child health examination with abnormal findings, has a notation for “pediatric diagnosis Age 0-17,” while code Z00.00, Encounter for general adult medical examination without abnormal findings, shows “Age - Adult Diagnosis Age 15-124).” For example, if a 16-year-old presents for a routine health exam without abnormal findings, which diagnosis code (adult or pediatric) should be reported and why? There are code edits with overlapping age ranges and it is not clear which code is appropriate for reporting purposes. ...

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