Pediatric Coding Alert

Watch out: Sometimes a well-check diagnosis isn't the way to go

You'll get paid the first time around for VEP tests if you use the payer-required V code and switch to a problem code when you should.

1. Track V Code Requirements

Because physicians often perform VEP during a preventive medicine service, you'll link 95930 (Visual evoked potential [VEP] testing central nervous system, checkerboard or flash) to one of two V codes. On your VEP tracking sheet, note a payer's ICD-9 requirement of either of these:

• V20.2 -- Routine infant or child health check

• V80.2 -- Special screening for neurological, eye conditions.

Most insurers cover the test during the well check with the preventive medicine service diagnosis. "Many commercial plans, as well as Aetna, accept V20.2 on the vision screening and on the preventive medicine service," says Diane C. Fulton, director of insurance/medical coding and billing for Diopsys Inc. in Pine Brook, N.J.

"Technically, V80.2 is a better code to use with 95930 because the specific V code describes why the provider is doing the procedure," Fulton says. Some health plans bundle screenings codes with V20.2. Therefore, a different ICD-9 code from the preventive medicine service's V code (V20.2) will show that the screening is a separate and identifiable procedure from the well visit (99381-99385 for new patients, and 99391-99395 for established patients).

Example: At a 3-year-old's established patient preventive medicine service, the pediatrician orders a nurse to test the child's vision using the VEP machine. The test shows the child has no functional asymmetries. On the claim, you report:

• 99392 (Periodic comprehensive preventive medicine reevaluation and management of an individual ... early childhood [age 1 through 4 years]) for the preventive medicine service

• 95930 for the VEP test

• V20.2 linked to 99392

• V80.2 linked to 95930 (V20.2 for Aetna).

2. Default to Problem Diagnosis When Found

Make sure you use the V code only when the screening is negative. When the test reveals a problem, switch to the problem diagnosis.

Example: A mother brings in her 6-year-old son. She's worried he may have learning disabilities because his teacher says he's not reading at the same level as his peers. A nurse administers a Conner's developmental test (96110, Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) that the pediatrician interprets as showing no problems. The pediatrician then has a nurse screen the child's vision with the VEP machine. The test shows a positive result: There are differences in each eye's response. The pediatrician reports a level-four office visit, which the coder enters on the CMS-1500 form with:

• Dx 1 V71.89 (Observation and evaluation for other specified suspected conditions)

• Dx 2 315.00 (Developmental reading disorder, unspecified)

• Dx 3 794.13 (Abnormal VEP).

Note: To indicate an unfound condition, such as delayed reading not found, the American Academy of Pediatrics recommends listing the V code first. Payers, however, may deny V71.89 as a primary diagnosis.

If the child tested normal (negative), you would bill 95930 with the condition, sign or symptom that prompted the test and V80.2.