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Sometimes I can find a symptom:

780.91 Fussy infant (baby)
780.92 Excessive crying of infant (baby)
780.95 Excessive crying of child, adolescent, or adult
780.7 Malaise and fatigue
780.99 Other general symptoms
792 Nonspecific abnormal findings in other body substances
799.3 Debility, unspecified
782.9 Other symptoms involving skin and integumentary tissues

Plus I might add these V-codes

V29 Observation and evaluation of newborns for suspected condition not
found
	V29.9 Observation for unspecified suspected condition
V71 Observation and evaluation for suspected conditions not found
	V71.9 Observation for unspecified suspected condition

This may be a helpful section of the ICD codes:
SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS (780-799)
This section includes symptoms, signs, abnormal results of laboratory or
other investigative procedures, and ill-defined conditions regarding
which no diagnosis classifiable elsewhere is recorded.
Signs and symptoms that point rather definitely to a given diagnosis are
assigned to some category in the preceding part of the classification.
In general, categories 780-796 include the more ill-defined conditions
and symptoms that point with perhaps equal suspicion to two or more
diseases or to two or more systems of the body, and without the
necessary study of the case to make a final diagnosis. Practically all
categories in this group could be designated as "not otherwise
specified," or as "unknown etiology," or as "transient." The Alphabetic
Index should be consulted to determine which symptoms and signs are to
be allocated here and which to more specific sections of the
classification; the residual subcategories numbered .9 are provided for
other relevant symptoms which cannot be allocated elsewhere in the
classification.
The conditions and signs or symptoms included in categories 780-796
consist of: (a) cases for which no more specific diagnosis can be made
even after all facts bearing on the case have been investigated; (b)
signs or symptoms existing at the time of initial encounter that proved
to be transient and whose causes could not be determined; (c)
provisional diagnoses in a patient who failed to return for further
investigation or care; (d) cases referred elsewhere for investigation or
treatment before the diagnosis was made; (e) cases in which a more
precise diagnosis was not available for any other reason; (f) certain
symptoms which represent important problems in medical care and which it
might be desired to classify in addition to a known cause. 
 SYMPTOMS (780-789) 
 NONSPECIFIC ABNORMAL FINDINGS (790-796) 
 ILL-DEFINED AND UNKNOWN CAUSES OF MORBIDITY AND MORTALITY (797-799)

Sometimes I feel truly stuck, and will give the diagnosis they came in
suspecting, plus the V-code for concern for condition not found.

For the 'omphalitis' patient, how about:

782.9 Other symptoms involving skin and integumentary tissues
plus
V29.9 Observation for unspecified suspected condition



Julie Brown, MD, MPH
Assistant Professor, Pediatric Emergency Medicine
Mailstop B5520
Seattle Children's Hospital
Seattle, Washington, USA
(206) 987 4016
 
 
-----Original Message-----
From: don zweig [mailto:[log in to unmask]] 
Sent: Wednesday, August 26, 2009 3:05 PM
To: Brown, Julie C.
Cc: [log in to unmask]
Subject: Re: Odd visits

What do you usually put on normal exam type cases so one may get  
paid?  is normal exam paid by insurance?

don
On Aug 26, 2009, at 2:30 PM, Brown, Julie C. wrote:

> I can't help but add to the list:
>
> 1.  The baby rushed back by a nurse for omphalitis and mottled  
> skin.  I
> washed off the gentian violet around the umbi stump, which was healing
> normally, and noted the normal if slightly reticulated skin with brisk
> capillary refill.  The tough part was what to give as a diagnosis for
> this beautiful perfectly healthy newborn.
>
> 2.  The 3-year-old with a small splinter brought in for streaking
> redness.  The resident told me she felt it was cellulitis with
> lymphangitic spread and suggested antibiotics.  On exam, it was such a
> linear streak leading away from the splinter, I asked if I could try  
> to
> wipe it off, even though Dad had already tried.  It came off with
> alcohol, after which Dad remembered that the child's preschool had
> served popsicles that day.  At least I could diagnose and remove the
> splinter.
>
>
> Julie Brown
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CONFIDENTIALITY NOTICE:  This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information protected by law.  Any unauthorized review, use, disclosure or distribution is prohibited.  If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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                 http://listserv.brown.edu/ped-em-l.html