Pediatric Coding Alert

Question: What should you code and/or charge for a prenatal consult?

Anonymous Mississippi Subscriber

Answer: The first step here is to define what you mean by consult. The meaning of consult in prenatal visits is not technically a consultation. It is a get- acquainted visit during which you discuss breast-feeding issues, circumcision, or other general issues having to do with the new baby. You should not bill these visits to insurance, since they are not medically necessary.

This type of prenatal consult is not an insurance matter at allbut it is a marketing one. Most pediatric practices feel they should accommodate these parents because a prenatal visit is a wonderful way to generate business. After all, in all likelihood youre going to have this childand any future siblingsin your practice for years. Thus, it will be an investment that will pay off. So our experts recommend not charging for this visit at all. If you refuse to even see the pregnant mother, your competition down the road will.

However, that doesnt mean you must perform this type of prenatal consult for free. If you decide that its important to your practice to charge, then you should explain up front to the parent who is making the appointment that there will be a fee.

How much could you charge? Our experts recommend that you charge somewhere around the same that you would for a second-level office visit, $25 or $30, even though the pediatrician may well spend a half hour talking to the mother, or both parents.

Tip: Some practices say that if the parent decides to use the pediatrician for the care of the baby, the fee used for the prenatal consult will be applied to the first office visit. The office carries the amount on the account as a cash credit, and then applies the credit to the co-pay or the deductible for the first visit.