Pediatric Coding Alert

Question: At a child's 1- and 5-year checkups, we perform a screening urinalysis and complete blood count. Should we use a well child diagnosis of V20.2 for these tests?


Massachusetts Subscriber

Answer: You should report diagnosis codes that represent the special screenings' purposes, rather than V20.2 (Routine infant or child health check). Code V20.2 describes routine vision and hearing exams, and developmental testing, according to the ICD-9-CM.

You should use separate diagnosis codes for any additional special screening exams. Choose the appropriate urinalysis (UA) and complete blood count (CBC) codes based on the exams' reasons.

Example: You perform an in-office UA (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 order a CBC (such as 85025, Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count]) for iron deficiency anemia.
 
In this case, code the tests as V74.8 (Special screening examination for other specified bacterial and spirochetal diseases) and V78.0 (Special screening for iron deficiency anemia) respectively.

Payer variations: Using separate ICD-9 codes for the additional screenings coding is technically correct based on V20.2's instructions. Insurers, however, also allow hemoglobin and urinalysis screenings with V20.2.