Pediatric Coding Alert

If you've been struggling with when to use V20.2 with preventive medicine associated services, ICD-9 has one simple answer.

"Coding Guidelines and Coding Clinic have both said that only the V20.2 (Routine infant or child health check) code applies to vaccines and other supplemental screening exams that are done as part of a well child exam," says Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine, Department of Pediatrics at Children's Healthcare of Atlanta at Egleston. That means, you're generally going to use V20.2 as the primary diagnosis code for any services associated with a well child exam (99381-99384 for new and 99391-99394 for established patients through 17 years).

"According to ICD, V20.2 is used for all developmental testing, age appropriate immunizations and routine vision and hearing testing," Linzer stresses. Here's how it works.

"Coding Clinic (1Q 2004, pp.14-15) clarified to use V20.2 as the diagnosis code when vision and hearing screening was part of the routine well child exam," Linzer says.

Example: A pediatrician performs vision and hearing screens at a 4-year-old established patient's preventive medicine service. You would code 99392 (Periodic comprehensive preventive medicine reevaluation and management of an individual ...; early childhood [age 1 through 4 years]), 99173 (Screening test of visual acuity, quantitative, bilateral) and 92551 (Screening test, pure tone, air only), all linked to V20.2.

If your office does visual evoked potential testing for amblyopia, you would similarly use V20.2 with 95930 (Visual evoked potential [VEP] testing central nervous system, checkerboard or flash), Linzer adds. "V80.2 (Special screening for other eye conditions) could be listed as an additional code."

Good news: Florida Blue Cross Blue Shield has gotten onboard with paying 95930 with V20.2, reports Diane C. Fulton, director of insurance/medical coding and billing for Diopsys Inc. in Pine Brook, N.J. Prior to this policy change, Aetna was the main insurer that paid 95930 with V20.2.

Have you weighed V79.3 (Special screening for developmental handicaps in early childhood) as an option for 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report))? "Remember, V79.3 is an excluded code from V20.2," Linzer points out.

Right way: If the physician performs the developmental screening as part of the well child exam, you would link it to V20.2, Linzer says. "If the pediatrician gave the testing for a specific reason, such as expressive language disorder (315.31), during the well child exam, then V79.3 could be used as a secondary code."

When you're tying an immunization administration code to a specific vaccine to avoid insurers viewing multiple administrations as duplicates, you should still list V20.2 first, according to ICD. Coding Clinic (4Q 1996, p. 50) states, "A code from V03-V06 may be used as a secondary code if the inoculation is given as a routine part of preventive health care, such as a well-baby visit."

What to do: "Based on Coding Clinic, the vaccines should be linked to V20.2 with the vaccine code as an additional diagnosis," Linzer explains. You could link the vaccine administration codes (90465-90474) to the vaccine code.

For instance, Linzer says a claim for Tdap (90715, Tetanus, diphtheria toxoids and acellular pertussis vaccine [Tdap], when administered to individuals 7 years or older, for intramuscular use) (V06.1, Need for prophylactic vaccination; diphtheria-tetanus-pertussis, combined [DTP] [DTaP]) and Menactra (90734, Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 [tetravalent], for intramuscular use) (V03.89, Other specified vaccinations against single bacterial diseases; other specified vaccination) that a nurse administers (90471, +90472, Immunization administration ...) to an 11-year-old could read:

• 90715 V20.2 (V06.1 optional additional dx)

• 90471 V06.1

• 90734 V20.2 (V03.89 optional additional dx)

• 90472 V03.89.

Although ICD-9 coding requires you to report only V20.2, not all payers follow these guidelines, explains Linda Walsh, Committee on Coding and Nomenclature manager and Division of Health Care Finance and Quality improvement director for the American Academy of Pediatrics in Elk Grove Village, Ill. "Therefore, in order to be paid, many/most members must utilize what we call 'acceptable' (as opposed to 'optimal') coding."

Best bet: Pay attention to payer guidelines because some may require you to use V03-V06 as the primary diagnosis code for immunizations administered at a preventive medicine visit. For these payers, link V20.2 to the preventive medicine visit (99381--"99395), and the appropriate V03-V06 code to the specific vaccine product (90476--"90748).