In the present scenario where enterovirus is doing the rounds in the United States, primary care physicians and facilities are very likely to face a tough time treating patients affected by the virus and managing the vital documentation tasks.
Medical coding for infectious diseases such as that caused by Enterovirus D-68 can be quite perplexing and requires the coder to have a clear idea regarding the medical terms and coding guidelines regarding it. The particular strain of virus/bacteria has to be reported using the correct diagnosis code on a reimbursement claim. Any kind of ambiguity or error in assigning the code can have serious repercussions for the physician practice/hospital or other healthcare settings.
Enterovirus Widespread in the U.S
It is reported that the United States is facing a nationwide outbreak of enterovirus D 68 that is associated with severe respiratory illness. CDC/state public health laboratories have confirmed at least 691 people in 46 states and the District of Columbia have been affected by respiratory illness caused by EV-D68. The EV-D68 infections are highest in summer and fall, and will decline later in the fall.
The CDC has asked clinicians to consider EV-D68 as a possible cause of “acute, unexplained severe respiratory illness, even if the patient does not have fever.” Among other directions given, physicians have been requested to “consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory illness in severely ill patients is unclear,” and to “consider testing to confirm the presence of EV-D68.” They can approach state health departments for diagnostic and molecular typing for enteroviruses.
Enterovirus D68 Striking Kids
Ebola has turned out to be deadly but the enterovirus D68 virus could be a more serious threat for American kids, according to the panel comprising infectious diseases experts at IDWeek 2014, Philadelphia, the annual gathering of IDSA (Infectious Diseases Society of America). The panel included the doctor who successfully led the treatment of Ebola survivors Nancy Writebol and Dr. Kent Brantly at the Emory University Hospital – Dr. Bruce Ribner. Another infectious disease was also pointed out due to its annual strike rate of 3000 to 49000 Americans though being entirely preventable – influenza.
Enterovirus D68 (EV-D68) is currently causing respiratory illness in kids all through the United States, with 45 reported to have been confirmed with it. Five children have already died from the virus and muscle paralysis has been reported in some children affected by the virus, particularly in the area in and around Denver, Colorado.
The California Department of Public Health now reports 32 EV-D68 cases all over the state. Symptoms for the virus begin with runny nose, sneezing, cough, fever and muscle and body aches and later develop into breathing issues. The muscle paralysis has not been confirmed to be a result of EV-D68, though enteroviruses do occasionally display signs of affecting the nervous system through conditions such as inflammation of the spinal cord and brain stem, and meningitis.
Preventive Measures Really Important
It takes up to two weeks for the virus to be tested. With the CDC (Centers for Disease Control and Prevention) reporting five deaths from this virus, parents are being briefed about preventive measures such as washing hands with water and soap, avoiding touching the nose, mouth and eyes without washing hands, not sharing eating or drinking utensils with sick people, and not kissing or hugging sick individuals. These steps are important particularly since no vaccines as well as specific treatment are available. Sick children showing signs of wheezing must be immediately reported since it is a significant enterovirus D68 sign.
Diagnosing and Documenting Infectious Diseases
Typically, microorganisms are identified using culture of body fluids or tissues or identification of antigens via techniques such as direct fluorescent antibody technique and qualitative/quantitative immunoassays. When the microorganism exists in minute numbers or is technically difficult to culture, these methods become problematic. It is also difficult to evaluate the effect of the treatment provided to the patient. Now, nucleic acid probes are available that allow speedy direct identification of microorganisms’ DNA or RNA. Techniques such as polymerase chain reaction (PCR) are used to identify the microorganism and its quantity. Moreover, patient response to treatment can also be correctly evaluated. CPT (Current Procedure Terminology) includes codes that describe the direct probe technique, amplified probe technique and quantification for 22 different microorganisms.
CPT code 87498 describes “Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, reverse transcription and amplified probe technique.” This signifies an “investigational” test, not a “medically necessary” one.
The ICD-9-CM code 008.67 represents “Enteritis due to enterovirus nec” and will be replaced by ICD-10-CM code A08.39 on October 1, 2015. These ICD codes are billable codes that can be used to specify a diagnosis on a reimbursement claim.
Accurate Healthcare Documentation Important
When faced with increasing cases of epidemics, doctors and other healthcare professionals in clinics and hospitals would be engrossed in rendering care, making arrangements for isolating patients with communicable diseases, improving infrastructure at the facility, and making the required changes to the treatment when required. The documentation responsibilities, which are very important for legal reasons and also for doctors and healthcare facilities to get paid for the services rendered, could fall short of accuracy.