Pediatric Coding Alert

Question: Are there any diagnosis codes used when a child comes in for a re-check and the problem is resolved? For example, for otitis media or bronchitis, we usually use 99213 for an office visit. And for the diagnosis we use 382.9 for otitis media, and 466.0 for bronchitis. Are there any resolved codes we should be using?

Pat Hollett, Office Manager
University Plaza Pediatrics, Garden City, NY

Answer: When a child comes in for a follow-up visit, you should always use the original diagnosisexactly as Hollett is doing. Thats because you are still treating that original condition. The child is there because you need to make sure the condition has been resolved. Yes, there is a code for a follow-up exam, but it is unspecificso unspecific, in fact, that many carriers will refuse to pay for it. It is V67.9 (unspecified follow-up examination). Some billers like the idea of being able to stick this code on all follow-up office visits. Dont do it. Its almost just as easy to go back to the original diagnosis code. Hollett is taking the correct approach.

Note that another reason to use the same diagnosis code for the recheck is that this is what insurance plans expect. Claims processors would probably just be confused if you use any code other than the original diagnosis code for resolved visits.

However, there is a possible problem with the CPT code, says Thomas Kent, CMM, a former pediatric practice manager and principal of Kent Medical Management in Dunkirk, MD. While it is possible that the doctor is performing a level three service, most recheck visits for resolved problems will only justify a level two visit, says Kent. I would be uncomfortable with a doctor who was charging 99213 for most resolved visits.

Finally, Kent notes that there are many other
possible otitis media diagnosis codes to use other than 382.9, which is an unspecified code. If possible, the pediatrician should review the otitis media section of the ICD-9 book and choose a more specific code, says Kent; for example, 381.01 for otitis media actue serous or 382.00 for otitis media acute suppurative. I would note that using a more specific diagnosis code on a recheck visit is especially important when the problem is not resolved, says Kent. This supports the higher level of service on a non-resolved recheck visit.