Coding for Jaundice
For The Record
Vol. 18 No. 1 P. 39

Jaundice causes a yellowish discoloration of the skin and the whites of the eyes. Usually, it is a result of an imbalance between the production and elimination of bilirubin, a substance produced by the breakdown of old red blood cells. Also called icterus, jaundice can occur in newborns, children, and adults.

Newborn Jaundice
Although some are born with jaundice, more than one half of all full-term babies and 80% of premature infants develop jaundice. Most infants develop jaundice on the second or third day of life. Jaundice is not necessarily a disease, but occurs due to the infant’s liver not being mature enough to metabolize the bilirubin. Jaundice lasts for a week to 10 days in full-term infants but longer in premature babies.

The signs and symptoms of jaundice include the following:

• yellowing of skin, which most often occurs first on the face and then on the chest, stomach, and legs;

• yellowing of the whites of the eyes; and

• lethargy.

The ICD-9-CM code assignment for newborn jaundice depends on the type and cause of the jaundice. Normal jaundice commonly seen in healthy babies is called physiologic jaundice (774.6). This type of jaundice typically appears on the second or third day of life. Jaundice that is present at birth or within 24 hours of birth may be the result of severe bruising (774.1), sepsis, or incompatibility between the mother’s blood and the baby’s blood (773.0-773.2). Jaundice that develops in or lasts past the second week of life may be due to liver malfunction (774.4), severe infection, an enzyme deficiency (774.39), or an abnormality of the baby’s red blood cells (774.0). Jaundice associated with other syndromes is coded first to the underlying disease, such as the following:

• congenital hypothyroidism (243);

• Crigler-Najjar syndrome (277.4); and

• Gilbert’s syndrome (277.4).

Code 774.31 is assigned as a secondary code when the jaundice is due to one of the above conditions. Jaundice associated with prematurity is classified to code 774.2.

Neonatal jaundice is diagnosed mainly by the physical appearance. The physician may press lightly on the baby’s nose, forehead, or chest to see the yellowing of the skin. In addition, the physician may use a transcutaneous jaundice meter to measure the baby’s bilirubin level. A blood test may also be done to more accurately measure the bilirubin level.

Mild jaundice may not require treatment. The jaundice will disappear on its own within one or two weeks. Do not assign a code for jaundice if it resolves without treatment and no work-up is required. Moderate or severe jaundice may require the following treatment to lower the level of bilirubin in the blood:

• Phototherapy — the baby is placed under special ultraviolet lights or wrapped in a fiber-optic blanket of lights, which changes the bilirubin into a form that can be eliminated by the baby’s kidneys. This treatment may last for several days.

• Intravenous immunoglobulin — transfusion of antibodies to decrease the jaundice. This type of treatment is done when jaundice is due to blood incompatibility between the mother and infant.

• Exchange blood transfusion — this rare type of treatment involves repeatedly withdrawing small amounts of blood from the baby, diluting out the bilirubin and maternal antibodies, and then transfusing the blood back into the baby.

If the jaundice goes untreated, it may result in kernicterus, which is brain damage caused by toxic levels of bilirubin. The baby may experience hearing loss, mental retardation, or behavior problems as a result of the brain damage. Kernicterus is classified to code 774.7 if it is not due to isoimmunization. If the kernicterus is associated with the isoimmunization, code 773.4 is sequenced first followed by the appropriate code from 773.0-773.2 to identify the type of isoimmunization.

Jaundice in Children and Adults
Jaundice is a symptom that may occur in other more serious conditions. It may be caused by the following:

• too many red blood cells retiring;

• the liver being overloaded or damaged; and

• the inability to move processed bilirubin from the liver through the biliary tract to the intestines.

Common causes of jaundice in children include the following:

• autoimmune hepatitis;

• biliary atresia;

• disorders present since birth that cause problems processing bilirubin such as Gilbert’s syndrome, Dubin-Johnson syndrome, Rotor’s syndrome, or Crigler-Najjar syndrome;

• hemolytic anemia;

• malaria; and

• viral hepatitis.

Common causes of adult jaundice include the following:

• alcoholic liver disease (alcoholic cirrhosis);

• autoimmune hepatitis;

• biliary stricture;

• blocked bile ducts;

• pancreatic cancer;

• chronic active hepatitis;

• drug-induced cholestasis;

• drug-induced hepatitis;

• hemolytic anemia;

• inadequate oxygen or blood flow to the liver;

• intrahepatic cholestasis of pregnancy;

• malaria;

• primary biliary cirrhosis; and

• viral hepatitis.

Jaundice, not otherwise specified and not of newborn, is classified to code 782.4. Since this is a symptom code, the related definitive diagnosis, if known, should be sequenced as the principal diagnosis. In many instances, jaundice will be included in the code for the underlying condition and not coded separately.

Coding and sequencing for jaundice are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Health Information Systems (800-367-2447), a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information.

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