Let Visit's Focus Determine Newborn Encounter Coding
Published on Sat Jul 21, 2007
5 scenarios walk you through using V20.2 versus a problem dx Not sure which diagnosis to use for hyperbilirubinemia checks with no problem found? Code V20.2 may be your answer.
Pediatricians have long struggled with the ICD-9 code to use for post-birth visits to check the baby's bilirubin level. The American Academy of Pediatrics (AAP) recommends that physicians examine most infants the first few days after discharge to assess the infant's well-being and the presence or absence of jaundice. But a specific ICD-9 code recommendation did not accompany the policy, leaving coders wondering which diagnoses apply, says Victoria S. Jackson, practice management consultant with JCM Inc. in California
In fact, the academy did hear your requests. The AAP asked for an ICD-9 code for a hyperbilirubin check in which no problem was found, says Jeffrey F. Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance and business affairs at EPG in Egleston, Ga. But CMS said no.
Instead: ICD-9 2007 added the notation "Initial and subsequent routine newborn check" following V20.2 (Routine infant or child health check) that indicated these encounters may fall under V20.2. You should still use another ICD-9 code when the infant has a problem or when the pediatrician suspects a problem at discharge that prompts the office encounter. These five examples walk you through the art of coding visits involving bilirubin checks.
Code Normal Visit as V20.2 Well Check When the baby has no problem and the pediatrician performs and documents all components of the health check, you'll match V20.2 with the child's first well check code. "You may count a first bilirubin check in which no problem is found as the initial preventive medicine service," says Richard Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio. After finding an infant healthy and normal, the pediatrician would continue to provide the rest of the services associated with the first well check visit.
Example 1: An experienced mother brings in a formula-fed infant who was discharged less than 48 hours after birth to see how the baby has transitioned to home life. The mother has no complaints at the visit. A nurse checks the baby's weight and finds no weight loss. The pediatrician asks questions about the baby's feeding and examines the newborn for signs of jaundice. He finds no current problems and performs and documents an age-appropriate history and examination including a phenylketonuria (PKU) screen.
Solution: Because the pediatrician does not find or treat any problems at this visit and instead performs the services associated with an initial preventive medicine service, you should report V20.2 and 99391 (Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination ...; infant [age younger than [...]
