Pediatric Coding Alert

Answer: Because the physician has already established the diagnosis of hyperlipidemia, you should use the available definitive diagnosis: hyperlipidemia (272.4, Other and unspecified hyperlipidemia) if the physician addresses or treats that condition at the preventive medicine service. The physician is supposed to code the diagnosis he knows at the end of the encounter, according to ICD-9 guidelines.

You would use a screening diagnosis when you are truly screening -- testing in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease. If the physician discovered the diagnosis during the screening then you would code the screening V code and may also assign the condition as an additional diagnosis, according to 2009 ICD-9-CM Coding Guidelines, Chapter 18, Section 5.

Example: At a 12-year-old patient's established preventive medicine service (99394, Periodic comprehensive preventive medicine reevaluation and management of an individual ... adolescent [age 12 through 17 years]), the pediatrician identifies the patient as at risk for hyperlipidemia and orders a dyslipidemia screening. You would use V77.91 (Screening for lipoid disorders).

Don't forget to code for the panel if you perform it in your office with 80061 (Lipid panel), which requires a certificate of CLIA waived status (modifier QW may be required depending on payer). Otherwise, you may be able to bill the collection with 36415 for routine venipuncture or 36416 for finger/heel stick.