Pediatric Coding Alert

Learn the benefits of V65.11 and other new ICD9 Codes

You will finally have a diagnosis to track "meet-and-greet" visits for expectant mothers - thanks to new ICD-9 codes that take effect Oct. 1. Other top pediatric code changes for 2004 include new diagnoses to describe visits for emergency contraceptive counseling and asthma-variant conditions.

Use V65.11 to Analyze Courtesy-Visit Payoff

Although V65.11 (Pediatric pre-birth visit) is a step forward for coding pre-birth visits, insurers probably won't cover pregnant moms "get acquainted" visits, says Richard H. Tuck, MD, FAAP, American Academy of Pediatrics (AAP) representative to the Review Update Committee. "A clearly defined E/M code still does not exist for the service," he says.

You should instead treat the pre-birth counseling visit as a freebie, says Jaime Darling, CPC, pediatric coding specialist for Graybill Medical Group, which has four pediatricians, in Escondido, Calif.

But you can use the V65.11 addition to track the new patients - and financial benefits - from providing the "get acquainted" service. Here's how: Suppose your pediatrician provides four meet-and-greet visits a month that take up 15 minutes each. You should report 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) for each visit linked to V65.11 and enter a $0 charge for the service. At the end of the year, you can run a report on the V65.11 visits and compare them to how many new patients the visits brought in.

If the pediatrician in the previous example treated paying patients rather than providing courtesy visits, she would bring in more than $55 per 99213 visit, which equates to $2,640 a year. You can compare the potential revenue figure to the money brought in from the meet-and-greet patients who convert to paying customers to see if the pre-birth visits are paying off.

Even though courtesy visits are not billable, you should charge for ob-gyn consultations for pregnant mothers carrying abnormal fetuses with a consultation code (99241-99245, Office consultation for the evaluation and management of a new or established patient ...), Tuck says. Use the suspected anomaly, such as 655.0x (Central nervous system malformation in fetus; fetal or suspected fetal anencephaly, hydrocephalus or spina bifida [with myelomeningocele]) or 655.1x (Chromosomal abnormality in fetus), for the primary diagnosis, and V65.11 in the second position.

If your pediatrician sees adolescents who need emergency contraception counseling and prescription, you will benefit from new code V25.03 (Encounter for contraceptive management; general counseling and advice; encounter for emergency contraceptive counseling and prescription) to describe the encounter, says Jeffrey Linzer Sr., MD, MICP, FAAP, AAP representative to the ICD-9-CM editorial advisory board.

For instance, 24 hours after having sexual intercourse in which the condom broke, a 16-year-old female presents for emergency contraceptive counseling and prescription. Starting Oct. 1, you should report the visit with V25.03, which offers more specificity than the previous nonspecific code V25.09 (... other), Linzer says.

493.8 Codes Describe Specific Asthma Problems

ICD 2004 also adds two new asthma diagnoses to describe specific respiratory conditions. Code 493.82 (Asthma, cough variant) now allows you to identify a child who has a chronic asthmatic cough without wheezing, Linzer says. If your pediatrician treats children who have asthma only when they exercise, you'll want to use new code 493.81 (Bronchospasm, exercise induced) for exercise-induced asthma. "These new codes allow you to single out the asthma problem," he says.

Sickle-Cell Diagnosis Requires Fifth Digit

Chronic-care coders will have two codes that specify whether a child's sickle cell (SC) anemia thalassemia is without crisis (282.41, Hereditary hemolytic anemia; sickle-cell thalassemia without crisis) or with crisis 282.42 (... sickle-cell thalassemia with crisis), Linzer says. "Because ICD-9 previously grouped SC thalassemia into 282.4 (... thalassemias), you had no way to track which patients were actually having problems," Linzer says.

Carnitine Disorder Additions Benefit Subspecialists

If you code for a neonatologist or pediatric endocrinologist, the new carnitine deficiency codes will come in handy for newborn problem coding, Linzer says. For an infant who is born with a metabolic disorder, you should specify whether the deficiency is primary (277.81, Other specified disorders of metabolism; primary carnitine deficiency) or due to:

inborn metabolic errors - 277.82, ... carnitine deficiency due to inborn errors of metabolism

a medical treatment - 277.83, ... iatrogenic carnitine deficiency

other secondary reason - 277.84, ... other secondary carnitine deficiency

other specified disorder - 277.89, ... other specified disorders of metabolism.

"ICD-9 previously lumped all these disorders into 277.8," Linzer says.

Make sure you note the revised influenza vaccine code (V04.81, Need for prophylactic vaccination and inoculation; influenza), which now requires a fifth digit. If you report V04.8 this fall for flu inoculations, you'll waste the season resubmitting claims. To prevent refiling hassles, update your flu vaccine diagnosis to contain a fifth digit of 1.