Pediatric Coding Alert

Question: When the pediatrician sees a patient on the WIC (Women Infant and Children) program, we typically have to perform an examination of weight, height, and blood values (requiring a blood draw) every six months, and then fill out a form for them to submit to WIC to keep getting benefits. How can we bill for these services?

New York Subscriber

Answer: There is no hard-cut rule on what to bill for these visits, but your practice should establish a policy to ensure that the instances are consistent from one patient to the next. 

Some practices choose not to bill as a courtesy for the patient, but optimal coding for this situation if a pediatrician is performing the visit would be to report 99212 (Office or other outpatient visit for the evaluation and management of an established patient…) with diagnosis code V78.0 (Screening for iron deficiency; anemia) and 783.9 (Other symptoms concerning nutrition, metabolism and development) as well as the codes for whichever lab tests are performed. An E/M documentation note is important to support the use of 99212 for this visit. If this was a nurse-only visit, then 99211 would be the appropriate code to use instead.