Pediatric Coding Alert

Question: Is reporting 99401 for perinatal counseling of a mom-to-be allowed? If so, what things do we need to keep in mind?

Kentucky Subscriber

Answer: Yes, you should be able to submit 99401 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes) ��" in certain circumstances.

Code 99401 represents a visit because the mom-to-be wants to meet with the pediatrician because of anticipated newborn concerns. No specific problem has arisen that needs discussion, but the parents might want to talk about breastfeeding versus bottle feeding, circumcision, or other issues. Although CPT does not include language supporting use of 99401 this way, the American Medical Association (AMA) has suggested 99401 as the appropriate code for a prenatal or perinatal visit.

Consult choice: If another physician refers the mom to your practice for discussion of specific issues (such as a problem with the fetus or a problem with the pregnancy that affects the fetus), you ould report a consultation code. For example, an ultrasound shows renal abnormalities so the obstetrician refers the mother to a pediatric nephrologist to discuss the issue and potential treatment options. The pediatrician could submit the appropriate consultation choice from 99241-99245 (Office consultation for a new or established patient ...).

In either situation, report diagnosis V65.11 (Pediatric pre-birth visit for expectant parent[s]).

Be aware: Insurance companies might -- or might not -- pay fo a "get acquainted" visit during the mom's pregnancy, so know your payers' guidelines. Some physicians view these visits as good public relations/practice builders and don't charge the patient or report the encounter to the insurer. If you file, report the best code from the 99401 series and include diagnosis V65.11 (Pediatric pre-birth visit for expectant parent[s]).