Pediatric Coding Alert

Question: What diagnoses apply when parents come in to discuss their child's health issues? Is there a single code that I should use?


Massachusetts Subscriber

Answer: A parent conference falls under V65.19 (Other persons seeking consultation; other person consulting on behalf of another person). In other words, the code describes a person seeking "advice or treatment for nonattending third party."

The counseling diagnosis code can be used when the patient is present or when counseling the parent/guardian(s) when the patient is not physically present.

Insurers may require supporting documentation for coverage of the encounter, so make sure you indicate the discussion's topic. Also, check if payers want a secondary diagnosis that indicates the topic.
 
Numerous diagnoses could apply to a child's health issue. Some possibilities include:

• ADD/ADHD -- 314.00, Attention deficit disorder; without mention of hyperactivity; 314.01, Attention deficit disorder; with hyperactivity

• anxiety -- e.g., 300.00, Anxiety state, unspecified

• depression -- e.g., 311, Depressive disorder, not elsewhere classified

• obesity -- 278.00, Obesity, unspecified.

Alternatively, the parents may want to discuss management of a chronic illness, such as asthma (493.xx) or diabetes (250.0x).

CPT code selection: When time spent in counseling and/or coordination of care constitutes over 50 percent of the face-to-face outpatient or floor inpatient time, CPT states that you can use time as the controlling factor to qualify for a particular level of E/M services. Because a pediatrician spends the majority of parent-only conferences on counseling, you may code these encounters based on time.

Use the total face-to-face time that the pediatrician spends with the parents to select the E/M service code. Careful supporting documentation of the time elements is critical.

Example: The parents of a hospital inpatient who is on kidney dialysis request a meeting with the staff pediatrician to discuss their son's complex medical problems and recent lab results. The pediatrician documents, "I spent 25 minutes discussing treatment options and test results." Because counseling dominates the visit, you should choose the E/M level based on the time the pediatrician spends talking to the parents. CPT indicates "physicians typically spend 25 minutes" on 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient ...).
 
So you should code the visit as 99232 with V65.19 and the end-stage renal disease diagnosis (585.6). If you use the expert-advised denotation of T/C (total encounter time/counseling time) to show that the visit was coded based on time, you would indicate 25/20 (some time is spent on history and medical decision-making).