Pediatric Coding Alert

Question: If a child comes in for a well visit and it turns out that the child is sickfor example with an ear infectionis that coded as a well-visit or a sick visit? Also, when the child comes in later for an ear recheck and to get the immunization, how is that follow-up coded?

Anonymous Colorado Subscriber

Answer: For the well visit, you can code for a sick visit too -- although some payers will not pay you for discovering an ear infection during a well visit. But to file for both, you should list the preventive medicine services code first, and the office visit second, with modifier -25 (significantly, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the office visit. As for the follow-up visit for the ear recheck, a resolved problem will have a lower-level office visit than a non-resolved problem. The diagnosis code for the recheck would be otitis media and with the follow-up code as a secondary diagnosis (V67.9), since the ICD-9 system does not include a code for resolved problems. For the immunization given during this recheck, you would code the vaccine product code and the administration code (90471 for one, 90472 for each additional).