It's important that you add contributing diagnoses, such as "cyanosis" or "apnea" that lead you to suspect the child had an ALTE. In fact in the ICD tabular the code says:
Use additional code(s) for associated signs and symptoms if no confirmed diagnosis established, or if signs and symptoms are not associated routinely with confirmed diagnosis, or provide additional information for cause of ALTE
This should help support the reason for observation.
Jeffrey Linzer Sr., MD, FAAP, FACEP
Associate Medical Director for Compliance
EPG/Division of Pediatric Emergency Medicine
Lead Physician, ICD-10-CM Transition Core Leadership Team
Children's Healthcare of Atlanta
[cid:[log in to unmask]]
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of james reingold
Sent: Wednesday, December 02, 2015 12:09 PM
To: [log in to unmask]
I find I am getting increased resistance to admitting infants with ALTE diagnosis, likely as administration gets more concerned about poor reimbursement for observation status admissions.
I have two questions.
1. How do you decide which infants who have had a spell require admit?2. Do you perform any studies in the ED for the vast majority of infants who are back to baseline by the time of their arrival to the ED and have normal vital signs and a normal exam?
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