Pediatric Coding Alert

Time is money, but it can also be good PR for your practice.

Do you ever meet with parents before their baby is even born? In these cases, you might be hesitant to charge for the visit because the patient isn't present yet--but can you collect anything for the physician's time? Check out the following options, along with our expert advice.

Consider how your office would code the following scenario: A pediatrician meets with an expectant couple so they can gauge whether they think the practice would be a good fit for their child, who is due in two months. Similar situations can occur with any types of new parent visits, such as prefoster or preadoption encounters, or families moving into the area or changing practices. Before billing these to insurance, follow these tips.

Considering an Office Visit?

Some practices think of meet-and-greets, in which they tell the parents about the way they run their practice, more as an office visit, such as 99201 (Office or other outpatient visit for the evaluation and management of a new patient ... Physicians typically spend 10 minutes face-to-face with the patient and/or family). However, this would need to be billed based on time to the mother's insurance company and would likely be questioned by the insurance company.

Easy: For practices that do charge for these services, there's a diagnosis code you can use: V65.11 (Pediatric pre-birth visit for expectant parent[s]). ICD-9 guidelines allow you to list the code as a first or additional diagnosis.

Ensure You Meet Criteria Before Using 99401-99404

As an alternative to using a problem-oriented office visit code, the American Academy of Pediatrics (AAP) suggests the pediatrician may deem a counseling or risk factor reduction code (99401-99404, Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure] ...) appropriate.

You may report these codes for prenatal counseling "if a family comes to the pediatrician/neonatologist either self-referred or sent by another provider to discuss a risk-reduction intervention (i.e, seeking advice to avoid a future problem or complication)," according to the AAP's Coding for Pediatrics 2009.

You would report the service under the mother's insurance, according to the AAP. Make sure you don't use 99401-99404 if the mother or her fetus has any existing symptoms, an identified problem, or a specific illness. "These codes are used to report services ... for the purpose of promoting health and preventing illness or injury," according to CPT®'s "Counseling Risk Factor Reduction and Behavior Change Intervention" guidelines.

Warning: Codes 99401-99404 aren't necessarily shoo-ins for typical meet and greets. The AAP gives the following examples of prenatal counseling encounters that qualify for 99401-99404. Scenarios include a mother with:

• a history of hypertension or diabetes
• a family history of a genetic disease
• a history of a premature neonate.

Most insurers do not pay 99401-99404. If, however, you have an insurer that covers the codes and you've met the above requirements, choose the appropriate code based on the prenatal counseling session's time:

The medical record must include "documentation of the total counseling time and a summary of the issues discussed," according to the AAP. Check out the academy's appropriate documentation example for 99401: "I spent 15 minutes with both parents reviewing the risks of recurrent preterm delivery and the mortality and morbidity risks if delivery occurs at less than 36 weeks."

Limit Consults to When Mother Has a Problem

You'll have an easier time giving the green light to coding for a prenatal visit in which another physician asks you to meet with the expectant mother. For insurers that still accept consultation codes (99241-99245, Office consultationfor a new or established patient ...), you can report the appropriate code from this range with a report back to the ob-gyn if the ob refers the patient to you and asks you to meet with the patient. This consultation would again be billed under the mother's insurance if the baby is still in utero.

"If an ob refers the patient to me I could technically bill a consult code but it would have to be totally time-driven because a pediatrician isn't going to examine an expectant mother," says Richard Lander, MD, FAAP, medical director with Essex-Morris Pediatric Group in New Jersey.

In these cases, the mother may be angry about you charging her a copay for the visit. Explain that copayments are an issue between the insurance holder and the insurer. Your office must follow these contractual agreements.

Think of Get-Acquainted Visits as Good PR

Some pediatricians simply consider doing meet-and-greets as good public relations (PR) and consider them a practice builder. "We don't charge patients or the insurance for these visits," Lander says. "The visits can get timeconsuming if you let them--several years ago, I was seeing maybe four or five prenatal visits a week."

Therefore, Lander uses a strategy that ensures that the visit won't span longer than 20 minutes. "I introducemyself, tell them about our basic philosophies, ask them a few questions (for instance, whether there are any genetic diseases in the family, if they'll be breastfeeding, if they plan to circumcise), talk to them about how our practice does not rush to give meds, and explain our other policies, and that way, most parents don't have many questions since I already gave a detailed explanation."

For those parents who do pull out a list of questions, Lander tells them he needs to get back with his patients, so he's happy to answer the parents' top two questions.

Tip: If you decide not to bill the service to the parent or the insurer, you might want to create an internal reporting code to use to gather data that you can use to evaluate meet-and-greets' value. You can later analyze the information to determine how many patients actually joined your practice following the meet-and-greet.