Pediatric Coding Alert

Question: What is the best code for monitoring an apparently normal, well newborn/infant with a family history of SIDS?

Ohio Subscriber

Answer: Although parents who have experienced the tragedy of sudden infant death syndrome (SIDS) would understandably want special monitoring for a sibling, the National Institutes of Health consensus conference contends that children with a family history of SIDS do not require additional formal monitoring. For counseling done with the family due to their anxiety assuming that more than 50 percent of the time of the encounter is spent on counseling bill office visits based on time. The closest available diagnosis code for a family history of SIDS is V19.8 (family history of other conditions; other condition).

Insurers will cover monitoring if it keeps the baby out of the hospital. SIDS is a different case, however. With SIDS, the baby doesnt first get sick: by definition, the child is normal and then, suddenly, dies. There is no expensive hospitalization for the insurance company to be concerned with. And because there is no indication that a family history of the condition places a child at increased risk, receiving reimbursement for special monitoring might be difficult.

Some insurance companies may pay for the monitoring equipment and your extra time based on a family history, however. And if parents demand an apnea monitor to help alleviate their concerns, you may choose to appeal to the insurance company.


Answers contributed by Susan Callaway, CPC, CCS-P, an independent coding consultant based in Augusta, S.C.; Thomas Kent, CMM, CPC, president, Kent Medical Management, Dunkirk, Md.; Richard A. Molteni, MD, FAAP, CPT editorial panel member, vice president and medical director of Childrens Hospital and Regional Medical Center, Seattle; Charles Schulte, MD, FAAP, chair, American Academy of Pediatrics coding and reimbursement committee, AAP representative on the AMAs CPT advisory committee, in practice at Countryside Pediatrics, Sterling, Va.; Peter Rappo, MD, FAAP, assistant clinical professor of pediatrics, Harvard University School of Medicine, in practice with Pediatric Associates Inc. of Brockton, Brockton, Mass.; and Richard H. Tuck, MD, FAAP, founding chair and member, American Academy of Pediatrics coding and reimbursement committee, in practice at PrimeCare Pediatrics, Zanesville, Ohio.