Pediatric Coding Alert

Question: A 17-year-old patient comes in for a preventive medicine exam. We use CPT code 99394 and ICD-9 code V70.0.

Code V20.2 seems more appropriate. What is the age determination for the code, which describes an "infant or child health check"?


California Subscriber

Answer: You're correct that you would typically use V20.2 (Health supervision of infant or child; routine infant or child health check) for a preventive medicine exam of a 17-year-old. In fact, the designation that appears in the ICD-9 manual next to V20.2 supports using the diagnosis code when the patient's age is between 0 and 17 years.

The usual cut-off age of 18 years for the infant and child health checkup code V20.2 -- and then V70.0 (General medical examination; routine general medical examination at a healthcare facility) from age 18 on -- comes from the CMS. The Medicare Outpatient Code Editor (OCE) places age limits on certain codes to detect inconsistencies between the patient's age and diagnosis.

Age symbols listed in the Additional Conventions section of ICD-9 alert you to these edits. For instance, a "P" in a yellow square means the ICD-9 code is for "Pediatric age: 0-17." Code V20.2 carries this designation, which means the diagnosis is "intended for children, and the patient's age must [be] between 0 and 17 years."

Do this: You should use V20.2 with infant (age under 1 year) through adolescent (age 12 through 17 years) preventive medicine service codes (99381-99384, Initial comprehensive preventive medicine evaluation and management of an individual ...; and 99391-99394, Periodic comprehensive preventive medicine re-evaluation and management of an individual ...).

Switch to V70.0 when a patient who is 18 or older presents for a well-check (99385-99387, New patient preventive medicine service; and 99395-99397, Established patient preventive medicine service).