Pediatric Coding Alert

Question: A nurse does a heel prick to collect a sample for phenylalanine (PKU). Which diagnosis code should I use? What if she performs the procedure as part of a well child check?


Florida Subscriber
Answer: Pediatricians generally use the term "PKU" to represent a panel of neonatal screening tests for various conditions in the newborn period. Each state has its own panel of tests ranging from four to nine separate exams.

A nurse usually obtains the blood sample for the panel via a heel prick in the hospital prior to the child's discharge. Sometimes, a nurse must collect an additional sample because of abnormal, incomplete or indeterminate results on the first exam. Here's how to code each of these scenarios:

1. When the nurse collects the sample (36416, Collection of capillary blood specimen [e.g., finger, heel, ear stick]) for the primary neonatal screening, you should code each specific screening test the pediatrician orders.

For example:
  V77.0 - Special screening for thyroid disorders
  V77.3 - ... phenylketonuria (PKU)
  V77.4 - ... galactosemia
  V77.6 - ... cystic fibrosis
  V77.7 - ... other inborn errors of metabolism (such as Maple syrup disease, medium-chain acyl CoA dehydrogenase [MCAD] deficiency)
  V78.2 - ... sickle cell disease or trait.

Problem: You may find coding the additional tests cumbersome due to claim submission forms that often limit the amount of diagnoses. In this case, insurers often permit 36416 linked to only V77.3. Although using one ICD-9 code doesn't paint the full diagnostic picture, reporting V77.3 accurately explains the blood collection reason - for PKU screening. 2. If a nurse performs an additional heel prick because the initial neonatal screening test showed abnormal findings, report 796.6 (Abnormal findings on neonatal screening) with 36416.