Pediatric Coding Alert

Question: What diagnosis codes should be used for otitis media rechecks. Our doctors usually put resolved, so we usually use V67.59 (follow-up examination following other treatment)?

Jeanne Thrasher, Insurance Clerk
Childrens Medical Group, Cumberland, MD

Answer: This is not recommended, however, according to Cecilia Willis, insurance/Medicaid billing clerk for North Mississippi Pediatrics, a seven-pediatrician, one-nurse practitioner practice in Tupelo, MS. You should use the same disease code on a recheck that you use for the initial visit, says Willis. Weve always coded the recheck with the same diagnosis code. The codes she uses for otitis media the initial visit where the problem is diagnosed, and the recheck visit are 382.9 (unspecified otitis media) or, occasionally, 380.9 (unspecified disorder of external ear). Whichever diagnosis code she uses for the follow-up visits, these visits are paid, she says. For Medicaid payers, youre definitely supposed to use the same code, and Im not aware of any managed care company that wants recheck pediatric codes.

Tip: Some billers use the follow-up V code in the secondary position on the claim form. This explains why it is important to be as specific as possible in the diagnosis codes you use for unresolved recheck visits.