Pediatric Coding Alert

Question: At a child's one- and five-year preventive medicine services, we perform a screening urinalysis and complete blood count. Should we use a well child diagnosis of V20.2 for these tests?


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Answer: Although the pediatrician performs these tests as a routine screening to rule out multiple problems and not for a specific reason, you should not report them with V20.2 (Routine infant or child health check). Evidence: Refer to ICD-9's inclusionS and exclusions. Specifically, under V20.2, ICD-9 directs you to "Use additional code(s) to identify: special screening examination(s) performed (V73.0-V82.9)."

When you look at ICD-9 coding guidelines, these codes fit your use of screening urinalysis and complete blood count (CBC) during a preventive medicine service (99381-99397, Initial/periodic comprehensive preventive medicine evaluation/re-evaluation and management of an individual ...).

"Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease," according to ICD-9 coding guidelines that classify screening categories as V73-V82 (Special screening examinations).

In contrast, V20.2 describes:

• developmental testing of infant or child
• immunizations appropriate for age
• routine vision and hearing exams. How to: You should report diagnosis codes that represent the special screenings' purposes, rather than V20.2. Choose the appropriate urinalysis and CBC codes based on the reasons for the exam.

Example: You perform an in-office urinalysis (such as 81002-QW, Urinalysis, by dipstick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy; CLIA waived test) to screen for an occult urinary tract infection, and you order a CBC (such as 85025, Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count) to screen for iron deficiency anemia.

In this case, code the tests' diagnoses as V74.8 (Special screening examination for other specified bacterial and spirochetal diseases) and V78.0 (Special screening for disorders of blood and blood-forming organs; iron deficiency anemia) respectively.

Payer variations: Using separate ICD-9 codes for the additional screenings' coding is technically correct based on the instructions for V20.2. Insurers, however, will typically also allow hemoglobin and urinalysis screenings with V20.2. Answers to You Be the Coder and Reader Questions reviewed/provided by Victoria S. Jackson, practice management consultant with JCM Inc. in California; Jeffrey F. Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance and business affairs at EPG in Egleston, Ga.; and Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio.