Pediatric Coding Alert

Question: A new mom-to-be visited our office because her doctor expects a complicated delivery and anticipates problems with the baby. The pediatrician spent a lot of time counseling the mom and reviewing medical records. Our office doesn't usually charge for "meet the doctor" visits, but this meeting was more involved than normal. Can we bill the visit to insurance or the patient?

Idaho Subscriber

Answer: The unborn fetus is not yet a patient for whom you can have a face-to-face encounter. Instead, the visit you describe qualifies as an office consultation on the mother, which you report as 99243 (Office consultation for a new or established patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of low complexity). List "consultation" as the type of service and send a report back to the obstetrician.

Report the service based on the pediatrician's time spent counseling, where she spent more than 50 percent of the total face-to-face time on counseling and/or coordination of care. CPT guidelines associate 40 minutes of face-to-face time with 99243.

Diagnose it: The anticipated delivery difficulties make the visit a problem-oriented consultation. Report diagnosis V23.89 (Supervision of high risk pregnancy). If, by contrast, you coded a "normal" prenatal visit, you would report V65.19 (Other person consulting on behalf of another person) instead. 

Advice: Many practices don't charge for prenatal "meet and greet" visits, as you note " but the scenario you describe isn't a meet and greet. You shouldn't have problems filing the claim with Medicaid or private insurance companies. Some practices discourage charging the mom-to-be if she has a co-pay or is self pay, however, in order to practice good public relations.