A pediatric chronic condition is a health problem that lasts over three months while also affecting the child’s normal activities and requires medical care and/or hospitalization(s). Approximately 15 to 18 percent of children in the United States live with a chronic health condition.
Some examples of pediatric chronic conditions include asthma, diabetes, epilepsy, sickle cell anemia, congenital heart disorders, and cancer.
Awareness of pediatric chronic conditions is imperative. We must factor children into the risk adjustment process. Chronic conditions at any age affect a healthcare organization’s ability to provide the quality healthcare needed at a hopeful low cost. The awareness of the pediatric chronic condition will ensure this vital data is captured in the medical record to help support the child’s health and the child’s caretakers.
Depression is an overlooked chronic condition, especially in pediatrics. Most would just write off depression signs as being a moody pre-teen or teenager. Children and teens are under a high amount of pressure and stress between home life, performing well in school, any other kind of extracurricular activities they are involved in, maintaining friendships, and other outside life factors. Suicide is the second leading cause of death between the ages of 10 to 34. According to the National Institute of Mental Health, between the ages of 10 to 14 there were 517 suicides and between the ages of 15 to 24 there were 6,252 suicides in the year 2017.
Epilepsy is the most common brain disorder in the United States with about 450,000 children under the age of 17 affected. By the time they are teenagers, about two-thirds of children with epilepsy outgrow their seizures. A doctor will diagnose a child with epilepsy if the child has one or more seizures, the doctor believes the child is likely to have another seizure, and the seizure was not directly caused by another medical condition.
With children, some congenital heart disorders are simple and do not require any kind of treatment. While other congenital heart disorders are more complex and require several surgeries performed a period of several years. The most common congenital heart disorders are; Atrial Septal Defect, Patent Ductus Asteriosis, Tetralogy of Fallot, and Ventricular Septal Defect. Since these are congenital conditions and not acquired over time, these conditions can and definitely should be coded for their lifetime.
Leukemia is the most common childhood cancer and accounts for almost 30% of all cancers in children.
Needless to say, risk adjustment coding and pediatric chronic conditions need to be more focused on as the risk adjustment coding field grows.