Considering the increase in measles cases in the United States and globally, it is a great time to review how we code for this condition. According to Centers for Disease Control and Prevention (CDC) data, updated on May 30, so far this year we have had 1,088 domestic measles cases, with three deaths.
These are confirmed cases reported by 33 states. CDC goes on to note there have been 14 measles outbreaks so far this year.
While the majority of the cases are in people 19 and younger, 32 percent of the cases are in people older than 20. Hospitalization was necessary in 12 percent of the total cases. While probable measles cases are being reported, the data CDC is reporting is only on confirmed cases.
We are certainly hearing more in the news recently about measles, and the CDC has addressed some reasons why there is more measles activity. Interestingly, measles was declared eliminated in the United States in 2000. The CDC attributes this to a very high percentage of people getting the MMR (measles, mumps, rubella) vaccine, with which we are all familiar. Currently, however, CDC notes that the U.S. MMR coverage among kindergarteners is now below the 95-percent target – and it is decreasing. The CDC also identifies an increase in global measles activity, citing more chances of an unvaccinated person infected with measles abroad returning to the United States.
Measles is a very contagious viral disease, with symptoms appearing 7 to 14 days after contact. Typical symptoms include a high fever, cough, runny nose, and red, watery eyes. Small white spots called Koplik’s spots may be seen inside the mouth 2-3 days after the onset of symptoms.
The characteristic measles rash appears 3 to 5 days after symptom onset, possibly with a fever spike of more than 104 degrees.
Looking at our coding, Measles is found at B05. In the Alphabetic Index, measles has inclusion terms of black, hemorrhagic, and suppressed. In the Index we also see the notation “with” and several conditions: complication NEC, encephalitis, intestinal complications, keratitis, meningitis, otitis media, and pneumonia, with a specific code listed for each.
We also see entries for French, German, and Liberty, all with the instructional note to see rubella. Rubella is a different condition, but has similar symptoms. Rubella is the “R” in the MMR vaccine. In the Tabular List, we see that Measles includes morbilli, which it may also be known as.
There is an Excludes 1 note for subacute sclerosing panencephalitis, so this rare measles complication is not coded here. The code listings for measles complicated by encephalitis, meningitis, pneumonia, and otitis media (code range B05.0-B05.3) all include the post-measles conditions. The encephalitis and pneumonia codes (B05.0 and B05.2 respectively) are Major Complication or Comorbidity (MCC) conditions.
The meningitis code, B05.1, is a CC condition. B05.4, Measles with intestinal complications, along with B05.81, Measles keratitis and keratoconjunctivitis, and B05.89, Other measles complications, are also CC conditions. B05.9, Measles without complications, would be our Measles unspecified code assignment.
For those of you who would like to track the data going forward, CDC updates their measles page every Friday.
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