Pediatric Coding Alert

Question: Our physician just purchased a non-invasive bilirubin assessment tool. What CPT code applies, and can we also charge for an office visit?

West Virginia Subscriber

Answer: The correct CPT code is 88720 (Bilirubin, total, transcutaneous). The Medicare Physician Fee Schedule does not assign any relative value units (RVUs) to 88720, which means your insurance companies might pay little or nothing toward the code. For example, Blue Cross reimburses approximately $20 in some areas, but other insurers in the same region pay less than $6. Your practice will need to establish a policy regarding whether you bill for the tips used during the test.

You'll also report an E/M code for the physician's service; this caliber visit typically merits 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...). Include modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and link the care to diagnosis 774.6 (Unspecified fetal and neonatal jaundice).