Pediatric Coding Alert

Question: An insurance company denied our claim for a lead test because we submitted a V code as the diagnosis. What's the correct diagnosis?

Vermont Subscriber

Answer: A V code should be acceptable, but the situation will determine the best choice.

Option 1: If the child has anemia associated with lead exposure, submit 285.9 (Anemia, unspecified). Report V15.86 (Contact with and [suspected] exposure to lead) for other signs associated with exposure. V15.86 is a secondary diagnosis code, so the payer might be denying your claim if you submit V15.86 alone.

Option 2: For screening without underlying factors, submit V82.5 (Special screening for other conditions; chemical poisoning and other conditions). Include any documentation explaining the test's necessity.

ption 3: Most insurance companies pay for lead screenings associated with V20.2 (Routine infant or child health check). Consider appealing to the insurer with a copy of the most recent guidelines for when to check for lead exposure. You can find national guidelines through the Centers for Disease Control and Prevention and more specific information from your local health department.