Pediatric Coding Alert

Question: Our pediatrician brushed fluoride onto a patient’s teeth. Can we report D1208 (Topical application of fluoride, excluding varnish) with the Z48.1 (Encounter for planned postprocedural wound closure) diagnosis code?

Answer: In order to reimburse for the professional services associated with the application of fluoride vanish, physicians must report 99188 (Application of topical fluoride varnish by a physician or other qualified health care professional) because insurers don’t typically recognize code D1206 for fluoride varnish by physicians. The correct diagnosis code is Z41.8 (Encounter for other procedures for purposes other than remedying health state) and not Z48.1 (Encounter for planned postprocedural wound closure).

Reminder: CPT^® included 99188 in 2015. Report this when the pediatrician gives the patient a fluoride varnish application. This could be administered by your nurse as an incident to service. Provision of dental services in the pediatric office is growing more common, particularly with Medicaid mandated dental reviews when in-depth dentist’s services are not required.