Pediatric Coding Alert

Should you charge for this traditionally free service?

The scene plays itself out throughout the country on a daily basis: An expectant mother walks into a pediatric practice to meet with a pediatrician prior to giving birth to ask questions about medical care for her soon-to-be-born child.

Policies on how to deal with such visits vary by practice. Some regard the visits as a courtesy, and do not charge for the encounter. Others believe that the visit should be billed as the pediatrician is providing a valuable service that should be compensated.

We asked our experts to weigh in on this tricky issue, and here’s what they had to say.

Who Should Attend the Visit?

Expectant parent visits are a great opportunity for parents-to-be to get to know the pediatrician, familiarize themselves with office policies and staff, and ask questions about the child’s postnatal care. While the American Academy of Pediatrics (AAP) recommends the visits to all families expecting a child, they believe the visits are crucial for “first pregnancies; parents who are new to the practice; single parents; families with high-risk pregnancies, pregnancy complications, or multiple gestations; and for parents who previously have experienced a perinatal death” (Source: pediatrics.aappublications.org/content/124/4/1227.full).

To document the visit, you should “place an appropriate ICD-10 such as Z76.81 [Expectant parent(s) prebirth pediatrician visit] on the problem list as an identifier that a meet-and-greet occurred,” suggests Donna Walaszek, CCS-P, billing manager, credentialing/coding specialist for Northampton Area Pediatrics, LLP, in Northampton, Massachusetts.

Coding alert: The Z76.81 code isn’t just for Mom. Dads, adoptive parents, and even same-sex partners are also covered by the code.

Code by Time for Counseling

There are no standard CPT^® codes associated with the service, but as “services like this are nearly 100-percent discussion, time as the key factor in leveling for evaluation and management [E/M] makes using 99201-99215 [Office or other outpatient visit for the evaluation and management of a new/established patient …] possible,” suggests Jan Blanchard, CPC, CPMA, pediatric solutions consultant at Vermont-based PCC. This will allow you to capture from 10 to 60 minutes, depending on the visit level,

More than likely, as a meet-and-greet, you will use one of the new patient sick visit codes (99201-99205). And add-on codes +99354 (Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour …) and +99355 (… each additionally 30 minutes …) could also come into play if the service goes beyond an initial 30 minutes.

Use Preventive Medicine Counseling When Appropriate

Another option would be to use a preventive medicine counseling code such as 99401-99404 (Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure) …). These codes are also time-based, allowing you to charge from 15 minutes (99401) to 60 minutes (99404) of counseling services as appropriate.

To Charge or Not to Charge

Many pediatric offices have traditionally offered such services for free, viewing them as a “cost of doing business,” in Walaszek’s words. “I like to think of it as a good faith first step to a long-term patient/medical home relationship, as many pediatricians will continue to maintain the relationship with the patient well into the patient’s adult life,” Walaszek adds.

But Blanchard offers a different take on this custom. “I always recommend charging for services rendered, especially when orienting a new family to your practice,” Blanchard counsels. “It sets a tone that says you value your own time, too. If your pediatrician sends the message that they don’t value their time, their patients won’t necessarily value it either,” Blanchard cautions practice managers.

If your pediatrician does decide to go this route, “transparency, research, and documentation is going to be the key to obtaining reimbursement for these types of visit,” suggests Walaszek. “Transparency, because the parent may not expect you to bill for the service; research, because due diligence in identifying the parent’s health insurance and determining any restrictions that might prevent you from obtaining reimbursement is going to be imperative; and documentation, because if you are going to bill to an insurance carrier, you will need to have documentation to support the service rendered,” Walaszek advises.

Some final advice: One main problem with billing for an expectant parent meet-and-greet will be who it is billed under. If it is billed under Mom (or Dad!), the payer may determine that this is a noncovered service. Offices need to be aware that this will hit the deductible and could cause either a co-pay or a payment in full if they have notmet their deductible, and you should inform the parent-to-be accordingly.

(For further information, go to pediatrics.aappublications.org/content/142/1/e20181218 or consult HaganJ. F., Shaw J.S., Duncan P., eds.  Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2017.)