Pediatric Coding Alert

Question: My co-workers think it's appropriate to use jaundice as the diagnosis in the following scenario: A nurse performs a weight and color check on a newborn whom the pediatrician wanted to see after discharge for suspected jaundice. The nurse notes, "No jaundice is found."
 
One colleague explains that 774.6 is appropriate because the diagnosis reflects why the pediatrician wanted to see the newborn. But I think we should assign V67.9 if the pediatrician treated the infant in the hospital for jaundice or V29.3 if the physician suspected the condition upon discharge. Which diagnosis do you recommend we use?

California Subscriber

Answer: The ICD-9 code that you should select depends on the hospital encounter. You are correct that you should use V29.3 (Observation for suspected genetic or metabolic condition) for suspected, unfound jaundice. But you should submit diagnosed jaundice that no longer requires treatment with 774.6 (Unspecified fetal and neonatal jaundice) and V67.9 (Surveillance only following completed treatment). Compare these two examples:
 
Suppose at the hospital the pediatrician thinks that the infant might develop jaundice due to slight bruising. Even though the initial bilirubin count shows an acceptable level, the pediatrician tells the parents to bring the infant in if he looks yellow. At the office visit, the nurse finds no signs of jaundice despite the parents' concerns. Because observation shows the suspected condition doesn't exist, you should assign 774.6 in the primary position and V29.3 as the secondary diagnosis. The diagnostic combination tells the payer that the pediatrician observed the newborn for a suspected metabolic condition: jaundice.
 
In this case, you should report 774.6 in the primary position and V67.9 in the secondary position. Code 774.6 denotes the treated condition. The V code indicates that the follow-up jaundice exam revealed that the patient's condition no longer requires treatment.