Pediatric Coding Alert

Key: Treat 'bili checks' as sick, not well visits

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. 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.

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. 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.

Some possible ICD-9 codes include:
  774.6 - Unspecified fetal and neonatal jaundice
  779.3 - Feeding problems in newborn

783.21 - Loss of weight
  783.41 - Failure to thrive. 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, [...]