Pediatric Coding Alert

BMI codes won't be for adults only

When your office provides burn or laceration follow-up care after Sept. 30, you can look forward to three essential new post-op care codes that may paint a better picture of the encounter and improve your payment.

Mark 0-2 to Signal Dressing/Suture-Related Visit

If you yearn for aftercare specificity, ICD-9 2007 answers your call with three new V58.3x codes. Now the designation "attention to surgical dressings and sutures" is a catchall for dressing changes and suture removal. When the new codes become effective Oct. 1, you'll be able to specify three aftercare types.
 
Catch: You'll have to add a flag to your system that V58.3 is no longer valid this fall -- it will require a fourth digit to indicate an encounter for:

• nonsurgical wound dressing change or removal, V58.30
 
• surgical wound dressing change or removal, V58.31
 
• suture removal, V58.32.
 
Hopefully, having a specific suture removal code will help practices get paid for 99211-99212 (Office or other outpatient visit for the evaluation and management of an established patient ...), says Victoria S. Jackson, practice management consultant with JCM Inc. in California. Payers may still require you to report the injury code (such as 883.0, Open wound of finger[s]; without mention of complication) as a secondary diagnosis to tie the original billing to the postoperative care, she says.
 
Action: If the pediatrician didn't perform the original laceration repair, code the suture removal with an E/M code and, starting Oct. 1, link it to V58.32. In Jackson's office, the physician always checks the wound before the nurse performs the removal. "So we use 99212 or 99213 depending on whether the laceration required steri-strips to keep closed."
 
Error averted: Do not separately bill the suture removal with an E/M code when the pediatrician placed the sutures. In this case, the laceration repair includes the postoperative care of removing the sutures in the 10-day global period.
 
Tip: To track nonbillable work, code follow-up visits with 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason[s] related to the original procedure) and either V58.32 for suture removal or V58.30-V58.31 for dressing change. The new diagnosis codes may be "used to track patient care and provide medical necessity, not just to get a claim paid," says Susan Vogelberger, CPC, CPC-H, CMBS, owner and president of Healthcare Consulting & Coding Education LLC in Boardman, Ohio.

Support Dietary Counseling With High-BMI Codes

In other news, the BMI codes head into the pediatric realm. ICD-9 2007 will introduce four new codes for pediatric body mass index (BMI). "This smart addition will help explain physician counseling (99201-99215) for obesity, as well as for failure to thrive," Jackson says. The new series will include:

• V85.51 -- Body Mass Index, pediatric, less than 5th percentile for age

• V85.52 -- Body Mass Index, pediatric, 5th percentile to less than 85th percentile for age

• V85.53 -- Body Mass Index, pediatric, 85th percentile to less than 95th percentile for age

• V85.54 -- Body Mass Index, pediatric, greater than or equal to 95th percentile for age.

New Hearing Exam V Code May Explain Retesting

The new edition of ICD-9 will introduce code  V72.11 (Encounter for hearing examination following failed hearing screening), which will help pediatric practices. Coders have not known which diagnosis code to report when children who fail their hearing screenings in school come in for further testing but end up with no positive results on the audiometry, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J. "This V code will be the appropriate code to use," she says.