ICD-10: R68.13

The ICD-10 code R68.13 is designated for the diagnosis of an Apparent Life Threatening Event in infants (ALTE). Here are the clinical details and descriptions associated with this code:

• Definition: ALTE refers to a sudden, brief episode in infants that appears life-threatening. It typically involves changes in color, breathing, or muscle tone, but without an identifiable medical cause. The key signs include apnea (temporary cessation of breathing), color change (such as pallor or cyanosis), and alterations in muscle tone [7][8].

• Classification: This code falls under the category of general symptoms and signs, specifically within the range of R00-R99, which includes symptoms, signs, and abnormal clinical findings not classified elsewhere. R68.13 is specifically categorized under R68, which pertains to other general symptoms and signs [3][4].

• Usage: R68.13 is a billable diagnosis code, meaning it is detailed enough to be used for medical billing and coding purposes. It is valid for use in HIPAA-covered transactions from October 1, 2024, through September 30, 2025 [1][12].

• Associated Codes: When using R68.13, it may be necessary to include additional codes for any associated signs and symptoms if a confirmed diagnosis has not been established [6].

• Clinical Context: The diagnosis of ALTE is important in pediatric care as it can indicate underlying health issues that may require further investigation. The descriptors for ALTE can be somewhat vague, which can complicate diagnosis and management [8].

In summary, R68.13 is a critical code for identifying episodes in infants that may appear life-threatening, necessitating careful clinical evaluation and management.

The ICD-10 code R68.13 refers to "Apparent life-threatening event in infant" (ALTE), which is a medical classification that encompasses a range of clinical presentations and characteristics. Here are the key aspects related to the clinical presentation, signs, symptoms, and patient characteristics associated with this condition:

Clinical Presentation

• Definition: An ALTE is characterized by a sudden, brief episode in an infant younger than one year that appears life-threatening but resolves quickly. This may include episodes of apnea (pauses in breathing), color changes (such as cyanosis or pallor), changes in muscle tone, or altered responsiveness [2][3].

Signs and Symptoms

• Common Symptoms:
• Apnea: A temporary cessation of breathing.
• Color Changes: Infants may exhibit cyanosis (bluish discoloration) or pallor (paleness).
• Altered Muscle Tone: This can manifest as either hypotonia (decreased muscle tone) or hypertonia (increased muscle tone).
• Altered Responsiveness: Infants may appear unresponsive or lethargic during the event [2][3][4].

Patient Characteristics

• Age: Typically affects infants under one year of age.
• Well-appearing Infants: Many infants who present with ALTE are otherwise healthy and well-appearing prior to the event [3][6].
• Risk Factors: Certain risk factors may be associated with ALTE, including a history of similar events, underlying medical conditions, or environmental factors [7].

Diagnostic Considerations

• ICD-10 Classification: The code R68.13 is used for billing and diagnosis purposes and is valid for patients aged 0 through 17 years. It is applicable for the current fiscal year for HIPAA-covered transactions [10][12].
• Diagnostic Testing: Infants experiencing ALTE may undergo various diagnostic tests, although many tests yield low diagnostic yield [6].

Conclusion

ALTE is a significant clinical event in infants that requires careful evaluation to rule out underlying conditions. The presentation can vary widely, but the common signs include apnea, color changes, and altered responsiveness. Understanding these characteristics is crucial for healthcare providers in managing and treating affected infants.

The ICD-10 code R68.13, which refers to "Apparent Life-Threatening Event in Infant" (ALTE), is associated with several alternative names and related terms. Here are some of them:

• Brief Resolved Unexplained Event (BRUE): This term has replaced ALTE in some contexts and refers to sudden, unexpected episodes in infants characterized by changes in breathing, skin color, or responsiveness, which resolve without intervention [8].
• Apnea of Prematurity: This term is used for apnea spells occurring in infants born before 37 weeks of gestation [5].
• Nonspecific Symptoms: R68.13 falls under the broader category of nonspecific symptoms, which includes various general symptoms and signs not classified elsewhere [1][6].
• Excessive Crying of Infant: Related codes include R68.11, which pertains to excessive crying in infants, indicating a spectrum of infant distress that may overlap with ALTE [6].

These terms and codes are important for medical classification and billing purposes, as they help in identifying and categorizing the symptoms and conditions related to infant health.

The diagnosis of an Apparent Life-Threatening Event (ALTE) in infants, classified under ICD-10 code R68.13, is based on specific clinical criteria. Here are the key points regarding the criteria used for diagnosis:

• Definition of ALTE: An ALTE is characterized by an event that includes a combination of symptoms such as color change (e.g., cyanosis or pallor), apnea (temporary cessation of breathing), changes in muscle tone, choking, and/or gagging. These events are typically frightening to the observer, often the caregiver or parent [2][7].

• Clinical Presentation: Infants who experience an ALTE often appear well after the event, which can lead to confusion regarding the severity of the situation. They may present to medical attention following a brief episode that raises concern [5][9].

• Risk Factors: Research has identified various risk factors associated with ALTE, particularly in infants who initially appear healthy. These factors can include age, underlying health conditions, and environmental factors [4].

• Exclusion of Other Conditions: The diagnosis of ALTE typically involves ruling out other potential causes for the symptoms observed. This may include conducting a thorough medical history and physical examination to ensure that the event is not attributable to other medical issues [9].

• Age Range: The ICD-10 code R68.13 is applicable for patients aged 0 through 17 years, emphasizing its relevance in pediatric care [10][13].

In summary, the diagnosis of ALTE under ICD-10 code R68.13 relies on the observation of specific symptoms during an event, the clinical presentation of the infant post-event, and the exclusion of other medical conditions that could explain the symptoms.

The standard treatment approaches for ICD-10 code R68.13, which refers to Apparent Life-Threatening Events (ALTE) in infants, focus on both immediate management and long-term care strategies. Here are the key components of treatment:

Immediate Management

• Assessment and Stabilization: The first step involves a thorough assessment of the infant's condition. This includes checking vital signs and ensuring the infant is stable. If the infant is experiencing apnea or significant distress, immediate resuscitation may be necessary.
• Monitoring: Continuous monitoring of the infant's heart rate, respiratory rate, and oxygen saturation is crucial. This helps in identifying any recurrent episodes and assessing the effectiveness of interventions.

Diagnostic Evaluation

• Investigations: A comprehensive evaluation may include blood tests, imaging studies, and possibly a sleep study to rule out underlying conditions that could contribute to ALTE, such as infections, metabolic disorders, or structural abnormalities.
• History and Physical Examination: Detailed history-taking from caregivers about the event, including any preceding symptoms, is essential for understanding potential triggers.

Long-term Management

• Education and Support for Parents: Parents should be educated about ALTE, including its potential causes and what to expect. Providing emotional support and resources can help alleviate anxiety.
• Follow-up Care: Regular follow-up appointments are important to monitor the infant's development and to reassess any ongoing risks or concerns.
• Consideration of Home Monitoring: In some cases, home monitoring devices may be recommended to track the infant's vital signs, especially if there is a history of recurrent ALTE episodes.

Referral to Specialists

• Pediatric Specialists: If necessary, referrals to pediatric pulmonologists, neurologists, or cardiologists may be made for further evaluation and management, especially if an underlying condition is suspected.

Conclusion

The management of ALTE is multifaceted, focusing on immediate stabilization, thorough evaluation, and ongoing support for families. The goal is to ensure the safety and well-being of the infant while addressing any underlying health issues that may contribute to these alarming events [2][14].