Pediatric Coding Alert

There are some CPT and ICD-9 coding and reimbursement challenges inherent when meeting with parents who are thinking about adoption. But there are also answers, including consultation codes, team conference codes, and billing parents directly.

When pediatricians meet with parents who are thinking of adopting a child, the meeting generally falls into one of two categories: Its either with parents who want to adopt, but havent settled on a particular child, or its with parents who have picked a child and have questions about the childs health, parenting issues, etc.

If the child is from a foreign country, the parents may want the pediatrician to review videotapes or adoption agency notes. If the child is in foster care in this country but has health problems, the parents will want to discuss this at length with the childs future pediatrician.

Using Consultation Codes

Sandy Farrell, insurance and billing manager for Alpharetta Pediatrics, based in Roswell, GA, uses consultation codes (99241-99245) for pre-adoption interviews when parents havent decided on a child yet. For the diagnosis code, she uses V68.89 (encounters for administrative purposes; other specified administrative purpose; other). Although most ICD-9 books dont mention it, this code is usually recognized by insurance companies as being specifically for adoption administrative purposes. If the meeting is about a specific child, but the child isnt presentfor example, the parents are showing photographs to the doctor for an assessmentthen Farrell would still use a consultation code.

Team Conference Codes Worth a Try

Another option is the team conference codes (99361, medical conference with interdisciplinary team of health professionals; approximately 30 minutes; and 99362, approximately 60 minutes). Sue Wilson, CPC, business office supervisor for Phoenix Pediatrics in Glendale, AZ, uses these codes instead of the consultation codes. Most of the meetings with parents at Wilsons practice involve children who have already been selected for adoption. Theyre not foreignrather, many are in foster care. They involve a lot of different people, she says. Theres someone from the adoption agency, theres a care giver (because often these children have health problems), and there are the prospective parents, she says. I called our insurance companies and secured pre-approval to code with the team conference codes.

The diagnosis coding is a bit different from foreign adoptions because these are children whose medical histories are known. Unfortunately, a lot of these cases involve a child with a handicap of some kind, Wilson says. So, when the childs history is available, you would use whatever diagnosis code is appropriate for the childs medical problem when you have the team conference.

Coding for Lab Tests

Often, children adopted from foreign countries have no medical histories. Pediatricians may order extensive lab work done one these children. But labs require appropriate ICD-9 codes on all orders.

Carin Harvey, office manager for Oak Tree Pediatrics in Northfield, NJ, uses V20.0 (health supervision of infant or child; foundling) for these tests. Thats the most specific code we can find, although it is pretty non-specific, says Harvey. Is there another optionwithout having to use six or seven different codes? she asks.

Farrell has a solution that works in her practice. Since labs do insist on specific codes, and dont usually like V codes, she lets the labs do the billing, she says. For example, if we are sending out a lot of strange labs, we just draw the blood here, she explains. Then we call the insurance company and ask them what lab they want us to send it to. Then she sends the blood to the lab with the request for tests. We let the lab bill the insurance company for the tests so they have to worry about coding it, she explains.

This will not apply, however, if your lab just sends you back a request for the necessary diagnosis codes. In this case, it is recommended to use the screening V codes. For example, use V73.89 (special screening examination for viral and chlamydial diseases; other specified viral diseases) if you are testing for a specific virus [except for polio (V73.0), smallpox (V73.1), measles (V73.2), rubella (V73.3), yellow fever (73.4), or other arthropod-borne viral diseases (V73.5), as these have their own codes]. Or, use V74.9 (special screening examination for bacterial and spirochetal diseases; unspecified bacterial and spirochetal diseases), but not for cholera (V74.0), pulmonary tuberculosis (V74.1), leprosy (74.2), diphtheria (V74.3), bacterial conjunctivitis (V74.4), venereal disease (V74.5), or yaws (V74.6), as these have their own codes. You could also use the exposure to V codes, such as V01.8 (contact with or exposure to communicable diseases; other communicable diseases).

Billing Parents Directly

Whatever the type of adoption or your type of approach, you need to address the issue of insurance coverage with these parents, urges Thomas A. Kent, CMM, former office manager of a pediatric practice and principal of Kent Medical Management in Dunkirk, MD. Visits prior to adopting the child will not be covered by many insurance plans no matter what tactics you use, he says. Accordingly, its a good idea to establish with these parents that they will be billed directly for these visits.

However, most plans will pick up coverage as the adoption process progresses, Kent notes. Advise the parents to talk with their insurance companies so they can determine when coverage will begin, what paperwork is needed to start the coverage, and what limitations there are to coverage. Staff should verify this information with parents, says Kent. Otherwise, the office will be billing and waiting for payment for services which are not covered and should be billed to the parents.