Additional Changes to Pediatric ICD 10 Codes RDNs Use for Reimbursement

Are you working with pediatric clients? Below are NEW changes & revisions to the ICD10 that could affect RDN Reimbursement

In November 2024 new ICD10 diagnosis codes were clarified for pediatrics.

There were changes shared last month and NOW there are additional clarifications this month. See the Academy of Nutrition and Dietetics member updates https://www.eatrightpro.org/news-center/member-updates/icd10cm-updates-whatrdns-need-to-know

Obesity Codes for Pediatrics

The NEW pediatric codes for BMI percentiles were added & are now—active

Z68.54   BMI pediatric 95th percentile to less than 120% of the 95th percentile

Z68.55   BMI pediatric 120% to less than 140% of the 95th percentile

Z68.56   BMI pediatric 140% of the 95th percentile & above

When billing the BMI codes above, the ICD10 diagnostic “E” code that was selected by the referring health care provider should also be included on the claim.

          E66.811 Obesity, class 1   BMI 30-34.9

          E66.812 Obesity, class 2   BMI 35-39.9

          E66.813 Obesity, class 3   BMI 40+

Updated ICD 10 diagnosis codes can be found April and October each year. World Health Organization (WHO) owns and publishes ICD-10. WHO allows the CDC National Center for Health Statistics (NCHS) to modify the codes for the U.S.  You can find these codes in ICD-10 CM (clinical modification) icd10cmtool.cdc.gov, www.cms.gov and  www.icd10data.com (American ICD-10-CM). To receive ICD-10 email updates from CDC, go to public.govdelivery.com

ICD10data.com will include a notation if the code is ‘billable’. Remember that is not necessarily that the insurer will consider it reimbursable. “Billable” allows the Clearing house (Availity, Office Ally and the like) to let the claim go through rather than reject and require a new ICD10 code.

Watch for updates on Instagram.com/mntreimbursement and facebook.com/mntreimbursement  Questions?  JOIN our weekly group Virtual Office Hours on Wednesdays 12pm Pacific/ 2pm Central/ 3pm Eastern https://www.mntreimbursement.com/weekly-virtual-office-hours