Pediatric Coding Alert

Pediatricians are all too familiar with the syndrome: The worried parent, especially the new one, who wants to bring the baby in just to make sure everything is okay. Maybe its a six-month-old whose mother thinks is teething. Maybe its a one-year-old who is cranky and maybe he has an ear infectioncould you just check? Maybe its a three-month-old who is spitting up. You see the child, and in fact, nothing is wrong. How do you bill for these visits?

The answer is to bill for the symptoms. You cant bill for parental anxiety. There is no such code. But especially when babies are concerned, there could be problems that arent immediately apparent, so you absolutely have to see the child if the parent is worried, sources tell us.

A lot of new parents come in because they need reassurance, says Doris Weir, CMM, office manager for Washington Pediatric Group of Sewell, N.J. And its very important to see every child if the parent calls in with anxiety, she says. Until the child is examined, you dont know whether the concern is warranted. And with babies, its especially hard to know. The mom could say the baby seems extra sleepy. That may not sound like much, but it could be.

Likewise, many new parents will bring in the child the first time he or she has a runny nose. This may be the childs first cold and usually doesnt necessitate an office visit. But, says Weir, you need to see the child anyway if the parent calls. In other words, pediatricians have to see these patients because they dont know whether the visit is necessary until after they have done the examination.

So how do you code the visit in terms of a diagnosis? Theres always some kind of symptom, says Weir. This is why its so important to get the parent to be as specific as possible about why he or she was concerned. The baby just wasnt acting right, is okay for starters, but you need to probe to get more specifics.

Worried Well Coding

There are two diagnosis codes that might seem appropriate for these cases: V65.5 (person with feared complaint in whom no diagnosis was made) and V71.9 (observation for unspecified suspected condition).

Also known as worried well, V65.5 is an excellent code for pediatrics, says Thomas A. Kent, CMM, president of Kent Medical Management in Dunkirk, Md., and former office manager of a pediatric practice. Worried well is not associated with hypochondria or psychological illness, he explains. Here are three examples from Kent in which V65.5 would be appropriate.

1. Just to make sure. A mother brings her child who recently got over [...]