Pediatric Coding Alert

Get-acquainted visits can benefit your practice in the long run, provided you stay in safe coding territory.

Consider how your office would code the following scenario. A pediatrician who joined a Pediatric Coding Alert subscriber's group asked the coder about reporting a prenatal visit in which the mom and dad come in to meet the doctor before the baby is born. The coder thinks the visit is more like a meet-and-greet that the practice would bill the patient, but the pediatrician said she had heard that physicians can bill the insurance for this service.

Does your office do get-acquainted visits? These can include new parent visits, such as prenatal, prefoster, or preadoption encounters, or young parent visits, for instance, for families moving into the area or changing practices. Before billing these to insurance, follow these do's:

"I think of meet-and-greets, in which I tell the parent(s) about the way we run our practice, more as an office visit, such as 99201 (Office or other outpatient visit for the evaluation and management of a new patient ... Physicians typically spend 10 minutes face-to-face with the patient and/or family)," says Richard Lander, MD, FAAP, pediatrician with Essex-Morris Pediatric Group in Livingston, N.J. To avoid the parent running away with the encounter, causing it to take 20 minutes or more, Lander controls the 10-minute agenda: "it's 'hello, these are our policies, goodbye.'"

His practice hasn't charged potential clients for these services in years. "It wasn't worth the paper work," he recalls.

Easy: For practices that do charge for these services, there's a diagnosis code you can use: V65.11 (Pediatric pre-birth visit for expectant parent[s]). ICD-9 2010 guidelines allow you to list the code as a first or additional diagnosis.

As an alternative to using a problem-oriented office visit code, the American Academy of Pediatrics (AAP) suggests the pediatrician may deem a counseling or risk factor reduction code (99401-99404, Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure] ...) appropriate.

You may report these codes for prenatal counseling "if a family comes to the pediatrician/neonatologist either self-referred or sent by another provider to discuss a risk-reduction intervention (i.e, seeking advice to avoid a future problem or complication)," according to the AAP's Coding for Pediatrics 2009.

You would report the service under the mother's insurance, according to the AAP. Make sure you don't use 99401-99404 if the mother or her fetus has any existing symptoms, an identified problem, or a specific illness. "These codes are used to report services ... for the purpose of promoting health and preventing illness or injury," according to CPT's "Counseling Risk Factor Reduction and Behavior Change Intervention" guidelines.

Warning: Codes 99401-99404 aren't necessarily shoo-ins for typical meet and greets. The AAP gives the following examples of prenatal counseling encounters that qualify for 99401-99404. Scenarios include a mother with:

• a history of hypertension or diabetes

• a family history of a genetic disease

• a history of a premature neonate.

Most insurers do not pay 99401-99404. If, however, you have an insurer that covers the codes and you've met the above requirements, choose the appropriate code based on the prenatal counseling session's time:

The medical record must include "documentation of the total counseling time and a summary of the issues discussed," according to the AAP. Check out the academy's appropriate documentation example for 99401: "I spent 15 minutes with both parents reviewing the risks of recurrent preterm delivery and the mortality and morbidity risks if delivery occurs at less than 36 weeks."

You'll have an easier time giving the green light to coding for a prenatal visit in which the mother has a problem. "We charge a consultation (99241-99245, Office consultation for a new or established patient ...) with a report back to the ob if the baby has known problems with important informed decisions to be made immediately upon birth," reports one coder in South Dakota.

Lander concurs with this practice. "I use a consult code, such as 99241 (... Physicians typically spend 15 minutes face-to-face with the patient and/or family), when an ob sends me a patient and requests my opinion on a specific issue and after the encounter I send a note back with my findings," he says. You would link 99241-99245 to the issue, such as an intrauterine or genetic condition.

In these cases, the mother may be angry about you charging her a copay for the visit, Lander warns.

Action: Explain that copayments are an issue between the insurance holder and the insurer, stresses Donelle  Holle, RN, principle of Pedscoding.com in Indiana. Your office must follow these contractual agreements.

Lander considers doing meet-and-greets good public relations (PR). "They help in building a practice."

Another practice that doesn't charge for these services agrees. "Meet-and-greets are a wonderful way to introduce prospective families to our office and start forming a relationship," says Linda Kortanek, executive practice director for Northpoint Pediatrics in Fishers, Ind.

Tip: If you decide not to bill the service to the parent or the insurer, create an internal reporting code to use to gather data that you can use to evaluate meet-and-greets' value. Lander had tracked how many customers became clients and found the rate pretty high. "The rate was higher when the expectant mother already had a child or children," he said.

Maybe people who are already in a pediatric group and are checking out other pediatricians are looking to change to a practice with different policies, Lander reasons. "I tell the potential client that we're not a big medicine practice and that we have evening hours."

At Northpoint Pediatrics, where they embrace meetand-greets like grade-school show and tell -- "we get the opportunity to 'show and tell' about our practice" -- the encounters are proven revenue raisers.

"Our statistics have shown -- if we can generate an interest in you talking to us as you are making your decisions about what practice to bring your children to -- we have a high probability of gaining a family for years," Kortanek raves.