Pediatric Coding Alert

Question: In addition to performing a PKU newborn screen, my pediatricians administer eight additional tests. Should I report each procedure individually, or does a combination code exist?

Wisconsin

Answer: The tests you describe are part of and state-required newborn screening tests. The government mandates screenings for newborns, phenylalanine (PKU) and congenital hypothyroidism addition to these national requirements, states the specific diseases that physicians must screen infants for to prevent mortality and morbidity state's population.

Some states, such as Hawaii, established a Metabolic Screening Program (NMSP), which fees and contracts with a centralized laboratory to newborn screening testing panels. Depending on the panel may contain numerous tests. For instance, Wisconsin, the panel consists of nine tests: deficiency, congenital adrenal hyperplasia (CAH), congenital hypothyroidism, cystic fibrosis (CF), oxidation, galactosemia, hemoglobinopathies, acidemia and PKU.

Coverage for the newborn screening panel is specific. Many insurers, such as Aetna; United; Blue Cross Blue Shield of Oregon, Michigan and Humana; and various Medicaid programs, including Colorado, Idaho and Wisconsin, cover the panel S3620 (Newborn metabolic screening panel, kit, postage and the laboratory tests specified by for inclusion in this panel [e.g., galactose; electrophoresis; hydroxyprogesterone, 17-d; [PKU]; and thyroxine, total]). Thus, you should payer for coverage policies.

In addition, you should note that S3620 postage. So, if the payer accepts S3620, you should report specimen handling. But, for carriers that do accept the HCPCS level-two code, you should appropriate handling code 99000 (Handling and/or conveyance of specimen for transfer from the office to a laboratory) for collection in the office.

Regardless of whether you bill S3620 or 99000, don't forget to report the heel stick. Neither of these codes includes collecting the blood sample, which you should report with 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]).