Based in Tulsa, Oklahoma, Outsource Strategies International (OSI) has vast experience in medical billing and coding, insurance verifications and authorizations, MRA/HCC Coding, HEDIS coding, and A/R reporting.

In today’s podcast, OSI’s Senior Solutions Manager Natalie Tornese discusses reporting pertussis (whooping cough) diagnosis and treatment.

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Hello everyone and welcome to our podcast series.

My name is Natalie Tornese and I’m a Senior Solutions Manager with Outsource Strategies International.

I wanted to take this opportunity to talk to you about whooping cough or pertussis.

Whooping cough or pertussis is a highly communicable, vaccine-preventable bacterial infection of the respiratory system that typically affects children. The CDC reported that of the more than 13,400 cases reported in 2018, there were 10 deaths from pertussis. Health officials say that it is even easier for whooping cough to circulate as schools reopen and recommend that adults and children have their immunization status checked.

Whooping cough is caused by a bacterium called Bordetella pertussis. The toxins released by the bacteria damage the cilia that line part of the upper respiratory system and make the airways swell. The condition is highly contagious and spread by coughing, sneezing, or by spending a lot of time near the affected person. Babies usually get the infection from adults or siblings, who are not even aware that they have the disease.

The most common symptoms of the condition are rapid coughs followed by a high-pitched “whoop” sound. The condition usually starts with symptoms that resemble a common cold. Early signs last for about one to two weeks and include runny nose, red watery eyes, sneezing, nasal congestion, low-grade fever, occasional dry cough, and apnea or a pause in breathing patterns.

The second stage, which may last from one to 10 weeks, is characterized by uncontrolled and prolonged coughing fits, followed by a high-pitched “whoop”. Attacks occur more often at night and other symptoms include accumulation of thick mucus, vomiting or choking, red or blue face, and fatigue. The third stage, which is the convalescent stage, can last for weeks or months.  It is characterized by a chronic cough with fewer sudden episodes.

The strenuous coughing can cause complications such as an abdominal hernia, broken blood vessels affecting the skin or the eyes, and fractured or bruised ribs. Whooping cough complications in children include apnea, brain damage, dehydration, ear infections, pneumonia, and seizures.

Physicians can diagnose whooping cough by evaluating the person’s medical history and current symptoms. However, as whooping cough in adults is not usually accompanied by severe symptoms, lab tests may be needed to confirm the diagnosis. Lab tests ordered would commonly include a nasal or throat swab, which involve collecting a specimen of secretions to test for  pertussis bacteria.

The treatment would depend on the duration of the illness and severity of symptoms. Pertussis is generally treated with antibiotics such as azithromycin, clarithromycin and erythromycin. Early treatment is critical to minimize the severity of symptoms and duration of the illness, and also to reduce the risks of people spreading the disease.

According to the American Lung Association, treatment after 3 weeks of the illness is unlikely to help though the bacteria have gone from the body. Symptoms will persist since the bacteria have already done the damage.

Unlike ICD-9 which had a separate code for any associated pneumonia as a secondary, ICD-10 has a combination code for whooping cough and pneumonia. I will include a transcript of all of this podcast outlining ICD-10 and CPT codes associated with this blog.

The CDC recommends vaccination as the best way to prevent whooping among infants, children, adolescents, and adults. Preventive antibiotics are also used to protect people who have been exposed and who are at high risk of developing severe pertussis. Infants and others at high risk for pertussis complications should be kept away from infected people.

The recommended pertussis vaccine for babies and children is called DTaP. In addition to pertussis, this combination vaccine can help protect against diphtheria and tetanus. A booster called Tdap for preteens, teens, and adults contains protection against tetanus, diphtheria and pertussis.

The recommended doses of these vaccines are as follows:

  • five doses of DTaP for children 2 months through 6 years of age
  • one dose of Tdap for those 11 years or older, with a preferred administration at 11 or 12 years of age, and
  • Tdap for pregnant women, with a preferred administration during the early part of gestational weeks 27 through 36

Despite the availability of a vaccination to prevent whooping cough, the number of confirmed cases each year in the United States is on the rise. In fact, CDC researchers analyzed lab samples from whooping cough patients between 2000 and 2013 and found that the vaccine used for whooping cough is less effective because the bacteria behind the disease has mutated.

I hope this helps, but always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening!