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Age of the Patient Matters

Created: 07/15/2015 | Updated:  
Please remember that the age of the patient can make a difference in coding an encounter correctly. If an age dependent code (either CPT or ICD-9) is chosen incorrectly, these encounters often stop on edits which may have been avoided.

ICD-9 Examples:
783.7 – Adult failure to thrive: Age 15 years – 124 years
783.41 – Failure to thrive in childhood: Age 29 days – 17 years
779.34 – Failure to thrive in newborn: Age 0 – 28 days

783.3 – Feeding difficulties and mismanagement (elderly) (infant): Age 29 days – 124 years
779.31 – Feeding problems in newborn: Age 0 – 28 days

780.60 – Fever, unspecified: 29 days – 124 years
778.4 – Neonatal fever: Age 0 – 28 days

ICD-9 conventions indicated by these codes include the following:
Newborn Age: 0             N
These diagnoses are intended for newborns and neonates and the patient’s age must be 0 years.
Pediatric Age: 0 - 17       P
These diagnoses are intended for the patients between the age of 0 and 17 years.
Adult Age: 15 – 124        A
These diagnoses are intended for the patients between the age of 15 and 124 years.

CPT Examples:
42820 - Tonsillectomy and adenoidectomy; younger than age 12
42821 - Age 12 and over
49500 - Repair initial inguinal hernia, age 6 mos. to younger than 5 years, with or without hydrocelectomy; reducible
49505 - Repair initial inguinal hernia, age 5 years or older: reducible
99143 - Moderate sedation services…….younger than 5 years of age
99144 - Age 5 years or older