Pediatric Coding Alert

Question: We do prenatal interviews in which expectant parents meet with a pediatrician to ask about our practice and policies. Can I use a consultation code for these sessions?


New York Subscriber

Answer: No specific E/M code exists for either prenatal interviews or meet-and-greet visits. Two options exist depending on the nature of the encounter:

Prenatal visits: You should code prenatal visits as consultations (99241-99245, Office consultation for a new or established patient ...) only if a professional source, such as an obstetrician, requests your opinion and you document the request, reason and your discussion/recommendation and send a report to the obstetrician. In this service, the pediatrician obtains medical histories of the parents, discusses any pregnancy issues, discusses first hours, days at home, when to make the first appointment, etc.

Meet and greet: Because a parent requests the service, you should revert to an office visit code (such as 99203, Office or other outpatient visit for the evaluation and management of a new patient ...). CPT 2006 eliminated confirmatory consults (99271-99275) that allowed you to bill a consultation requested by a patient and/or family. Some practices treat these courtesy visits, in which the pediatrician gives no medical advice gratis, as a courtesy service and possible marketing tactic to meet potential customers and discuss office, practice style, etc. You may charge a flat fee for a non-established patient.
 
Tip: Select the appropriate level of E/M service based on time. When counseling and/or coordination of care comprises the majority of an encounter, CPT allows you to code the visit using time as the determining element. No exam is required when billing based on time.

Billing: Make sure to bill the mother's insurance, because she is the patient.

For either prenatal interviews or meet-and-greet visits, link the E/M service code to V65.11 (Pediatric pre-birth visit for expectant mother). If a defined problem exists that led the OB to request the consult, also code for the problem, such as 764.9x (Slow growth retardation, unspecified) or 766.1 (Other "heavy-for-dates" infants). For a high-risk pregnancy, add an additional V code: V23.89 (Other high-risk pregnancy).