Pediatric Coding Alert

When evaluating a newborn after a hospital discharge, don't fall into the trap of coding a well visit consider the visit a follow-up hospital visit and you'll ethically optimize your practice's reimbursement. Explain the Visit With Your Current or Initial Concern Remember, if you or others from your practice provided newborn care, the infant is considered an established patient even on its first visit to your office.

If the baby has minor problems at the visit, you should bill a "sick visit" (99212-99215, Established patient office visit) with the proper diagnosis codes, says Richard A. Molteni, FAAP, medical director of Children's Hospital and Regional Medical Center in Seattle. Select a diagnosis code that reflects any problems the baby might have. For example, if the baby is losing weight, use 783.21 (Loss of weight). If the baby has jaundice that requires treatment, assign 774.6 (Unspecified fetal and neonatal jaundice). For feeding problems, you can assign 779.3 (Feeding problems in newborn). Code this visit 99213 or 99214. If the baby is well at the visit, use a diagnosis code that reflects your reason for wanting to see the baby. For example, in the hospital the baby might have lost weight, but might have gained weight by the four-day visit in your office. You can still code feeding problems (779.3), because that concern prompted the visit. Or you might have been concerned about possible jaundice, but when you see the baby at four days of age the jaundice had resolved. You can still bill for jaundice (774.6), Molteni says. CPT codes for these visits would likely be 99212 or 99213. Because of heightened medical risk when the patient is a newborn, rule-out codes and V codes can sometimes be used. The V29.x series represents observation for a suspected condition in a newborn, says Jeffrey Linzer Sr., MD, FAAP, MICP, Academy of Pediatrics representative to the ICD-9-CM editorial advisory board. Coupled with a diagnosis code, V29.x (Observation and evaluation of newborns and infants for suspected condition not found) can signify that the physician is concerned about a problem but did not find it upon examination, says Linzer, also a professor of pediatrics at Emory University in Atlanta. In a baby in whom colic is a concern but not found, for example, use 789.0x (Abdominal pain) as the primary diagnosis code, followed by V29.x. This coding combination shows that the pediatrician saw the child to rule out colic. Assign a Nurse Visit to Simple Weight Checks The pediatrician sometimes just wants to weigh the infant on a three- or four-day visit. The nurse weighs the baby, and if the weight has increased, notes it and sends him or her home. You should bill 99211 only, [...]