Pediatric Coding Alert
4 Guidelines for Coding Jaundice Follow-up Encounters
Key: Treat 'bili checks' as sick, not well visits 1. Use a Sick Visit Code First, you should consider the above real-world coding scenario a sick visit. "Our providers say this is not a normal well-child exam," Bibian says. 2. Report Definitive Diagnosis The easiest ICD-9 coding option occurs when the newborn has a problem or symptom at the time of encounter. If the patient has developed jaundice, lost weight or is having feeding problems, you should report the definitive diagnosis or symptom. Good news: You'll often be able to use one of the above-listed diagnoses for the hospital follow-up visit. "When we see the babies, very few have regained birth weight, some are jaundiced, most parents have feeding questions, etc.," Scott says. You may also assign a diagnosis that represents the parent's complaint or the pediatrician's hospital concern. If the parent has any complaints at the time of the encounter, the physician should select a corresponding code, says Jeffrey Linzer Sr., MD, MICP, FAAP, AAP representative to the ICD-9-CM editorial advisory board. He could also report a code "based on conditions at the time of birth that may be contributing to the encounter," Linzer says. You should consider two additional V codes for hospital follow-up visits in which the newborn exhibits no signs or symptoms. If you want to monitor the newborn's continued weight gain, but the infant has not lost weight, ICD-9 offers V65.3 (Dietary surveillance and counseling). This code can also be useful for encounters in which the pediatrician counsels the parent on feeding issues.
You can avoid incorrectly using up one of a newborn's allotted preventive medicine services, as long as you charge an office visit, not CPT 99391 , when you see a patient for a hyperbilirubinemia and a weight check after discharge.
The American Academy of Pediatrics recommends that pediatricians examine all infants "in the first few days after discharge to assess infant well-being and the presence or absence of jaundice," according to Management of Hyperbilirubinemia in the Newborn Infant 35 Weeks or More of Gestation. But many providers are unsure how to bill these visits.
Case study: Leticia Bibian, director of patient accounts at Northeast Valley Health Corp. in San Fernando, Calif., says her pediatricians see newborn babies three to five days after birth to check if the baby is feeding well, to check his weight, and determine if there is jaundice. "How would you code this type of visit?" she asks.
The visit is to check for specific problems. "The encounter is for a follow-up of the hospital visit and to ensure the transition home has gone well," says Charles A. Scott, MD, FAAP, pediatrician at Medford Pediatric & Adolescent Medicine PA in Medford, N.J.
Solution: Report a postdischarge bilirubin/weight check with the appropriate-level office visit code (99201-99215, Office or other outpatient visit for a new or established patient ...). If the pediatricians initially saw the newborn in the hospital, code an established patient office visit (99212-99215).
Reserve the initial well-visit code for when the parent and infant return for the "first official" well-child checkup, usually a week later. "Use V20.2 (Routine infant or child health check, including immunizations appropriate for age) at that visit with 99391 (Periodic comprehensive preventive medicine re-evaluation and management of an individual including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization[s], laboratory/diagnostic procedures, established patient; infant [age under 1 year])," Scott says.
Some possible ICD-9 codes include:
3. Code Complaints, Birth Problems
Using these principles, the code for a "bili check" in which the pediatrician finds no jaundice may include any of the following:
4. Apply V Codes for 'No Problem' Visit
Another possible diagnosis for a "no problem" recheck is V29.x (Observation and evaluation of newborns and infants for suspected condition not found). "Code V29.8 would most likely apply to the evaluation of jaundice not found," Linzer says.
Pediatric Coding Alert
- Surprise:
Pharmacologic Management Doesn't Correctly Describe ADD Follow-up Visits
Better method: Bill rechecks with 99212-99215, not CPT 90862
When coding [...] - Payers May Adopt Medicare Observation Care Rules
Choose between 99217-99220 and 99234-99236 based on date, time
If you let your observation care service [...] - You Be the Coder:
Find Failed Hearing Test's Correct ICD-9 Code
Question: A child came in for a hearing exam in which the pediatrician found normal [...] - Use This Chart to Select the Right Observation Code Every Time
Extended single-day observation admit, discharge should pay the same as 2-day services
If a [...] - 4 Guidelines for Coding Jaundice Follow-up Encounters
Key: Treat 'bili checks' as sick, not well visits
You can avoid incorrectly using up one of [...] - READER QUESTIONS:
Simple Tool Fights Code Nonrecognition
Question: An insurer that we frequently bill rejects new vaccine CPT 90714 because [...] - READER QUESTIONS:
Apply Standard Terms to ICD-9 Codes
Question: Are there definitions to the 995.5 diagnoses, such as 995.59? Also, what [...] - READER QUESTIONS:
Don't Stress About Modifier 57 Nonuse
Question: I noticed modifier 57 in CPT Appendix A. As a general pediatrician, I have [...] - READER QUESTIONS:
Rocephin Shot Requires 2 Codes
Question: For a Rocephin injection, is it better to use J0696 or 90788? Insurers pay [...] - Top-Notch Telephone Management for the Medical Office
Presented by Victoria Jackson
The following supplement to Pediatric Coding Alert is the transcript of a [...]
