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Medical Coding News Archives

NIH Publishes New Guidelines for Diagnosing Fetal Alcohol Syndrome

August 24, 2016:

On August 10, the National Institutes of Health (NIH) released new proposed clinical guidelines for diagnosing fetal alcohol spectrum disorder (FASD). These guidelines, which update those issued more than 10 years ago, provide a new definition of documented prenatal alcohol exposure, guidelines for evaluating facial and physical deformities associated with FASD, and updated discussions of the impairments characteristic of each FASD subtype.

The new guidelines were developed based on a year-long analysis of 10,000 participants in studies of prenatal alcohol exposure. The studies were funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the NIH.

It is estimated that as many as 5 percent of children in the United States show signs of prenatal alcohol exposure. Such signs include low IQ, restricted growth, small head size, facial deformities, and various behavioral issues.

The new guidelines still recognize four diagnostic categories within FASD: fetal alcohol syndrome (FAS), partial FAS, alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD) for children with a physical malformation.

What is new is the more detailed definition of documented prenatal alcohol exposure. Such exposure is indicated when the mother has a documented alcohol-related social or legal problem during pregnancy, or when the mother or reliable source reports consumption of the following during pregnancy:

• Six or more drinks per week for at least two weeks

• Three or more drinks on two or more occasions

The guidelines also now include information on how to assess lip/philtrum abnormalities and a scoring system for physical deformities associated with FAS.

The guidelines note that all children diagnosed with FASD, except those with ARBD, must have cognitive or behavioral impairments. In the past, children without neurobehavioral impairment could be diagnosed with FASD based on characteristic facial features, growth restriction, and head size. The new guidelines also include epilepsy or recurrent seizures as possible signs of FAS or PFAS.

The guidelines were published in Pediatrics ( http://pediatrics.aappublications.org/content/138/2/e20154256?download=true).

The most common ICD-10-CM codes to use to report FASD, PFAS, ARBD, and ARND are too numerous to list here, but a fairly comprehensive list is posted on the American Academy of Pediatrics web page. Note that for 2017, the “(suspected to be)” nonessential modifier has been removed from codes P00.0-P04.9.


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