Pediatric Coding Alert

Keep in mind, however, that your CPT® codes will stay the same.

With ICD-10 barreling ahead and scheduled to take effect in a few short months, you’re probably finalizing your conversion plan so you’ll be ready to submit clean claims on Oct. 1. However, if your practice still has some loose ends to tie up, you aren’t alone.

A subscriber wrote to Pediatric Coding Alert recently and asked the following question: “How will ICD-10 affect the use of CPT®, especially in relation to well child visits?” Read on to nail down how you’ll report preventive care come October. 

Status Quo Reigns for CPT®

The good news about the ICD-10 implementation is that nothing will change with your CPT® coding—you will continue to use the exact same CPT® codes for all visits that you report now. For example, if you see a three year old established patient for a preventive visit, you’ll still report 99392, just as you would now. 

Your diagnosis codes will be the only things that change in October, as you stop using ICD-9 codes and start using codes from the ICD-10 set. Therefore, if you’ve gotten accustomed to having V20.2 as a catch-all for your well child visits, get ready for a makeover. 

In October, you’ll instead use Z00.129 (Encounter for routine child health examination without abnormal findings) to reflect the physician’s well child visit during which no abnormal findings are discovered. If the physician encounters abnormal findings during the visit, you’d instead report Z00.121 (Encounter for routine child health examination with abnormal findings).

If the pediatrician does come across an abnormal finding and you plan to report Z00.121, be sure and maintain thorough documentation of the abnormality. For instance, the physician might examine the patient and record, “patient has an excessive amount of cerumen in her left ear.” 

Note: “Abnormal findings” does not refer to a blood test, biopsy, or a test that went to pathology. Often, these significant abnormal findings would support a separate E/M visit billed with a modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) at the time of a preventive medicine visit.