Pediatric Coding Alert

Pediatricians must order tests on newborns, and some of these tests may be esoteric. Hospitals frequently require pediatricians to provide the proper diagnosis code on lab requisitions. Choosing the correct diagnosis code when you do not yet know a diagnosis means relying on V codes to ensure the appropriate tests are ordered.

Pediatricians should be aware of the full gamut of possible diagnosis codes to use when ordering these tests, including V17.x (Family history of certain chronic disabling diseases), V18.x (Family history of certain other specific conditions), V19.x (Family history of other conditions), V71.89 (Observation for other specified suspected conditions; other specified suspected conditions), V72.x (Special investigations and examinations), V77.x (Special screening for endocrine, nutritional, metabolic, and immunity disorders) and V78.x (Special screening for disorders of blood and blood-forming organs).

In addition to choosing the appropriate diagnosis code, pediatricians can bill for obtaining the specimen, either by heel stick (36415*, Routine venipuncture or finger/heel/ear stick for collection of specimen[s]) or venipuncture (36406, Venipuncture, under age 3 years; other vein). If the pediatrician draws blood for a repeat test in the office after the baby has been discharged, you should use these codes as well. You should only bill these CPT codes for tests, however, if you or your lab performs the test. Use the appropriate diagnosis code for ordering the test: either a screening code (V72.x or V77.x) or, if the condition is suspected, a family history code (V17.x-V19x) or a suspected condition code such as V71.89.

One test, for phenylketonuria (PKU, 84030), is performed for every baby. The diagnosis code to use when ordering this screening test is V77.3 (Special screening for endocrine, nutritional, metabolic, and immunity disorders; phenylketonuria [PKU]). Although every state requires screening for PKU, this does not necessarily mean that it will be reimbursed, says Charles Scott, MD, FAAP, who practices with Medford Pediatric and Adolescent Medicine in Medford, N.J.

Other screening tests may include those for hypothyroidism (84437 and V77.0, thyroid disorders), galactosemia (82776, Galactose-1-phosphate uridyl transferase; screen; and V77.4, galactosemia), maple syrup urine disease (84510, Tyrosine; and V77.7, other inborn errors of metabolism), homocystinuria (82615, Cystine and homocystine, urine, qualitative; and V77.7), biotinidase deficiency (82261, Biotinidase, each specimen; and V77.7), cystic fibrosis (83516, Immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantitative; multiple step method; and V77.6, cystic fibrosis), adrenal hyperplasia (83498, Hydroxyprogesterone, 17-d; and V77.7), toxoplasmosis (86777, Toxoplasma; and V75.8,Special screening examination for other infectious diseases; other specified parasitic infections) and hemoglobinopathy (83020, Hemoglobin fractionation and quantitation; electrophoresis [e.g., A2, S, C, and/or F]; and V78.3, Special screening for disorders of blood and blood-forming organs; other hemoglobinopathies).

A test occasionally is conducted because there is a family history of a condition. For example, a baby is born to parents, and the father has sickle-cell trait. The baby is tested for sickle-cell trait and disease. You should use a code denoting family history of the condition, such as V18.3 (Family history of certain other specific conditions; other blood disorders), when ordering the test.

When a baby has a symptom that prompts the pediatrician to order a certain test, use that symptom as the diagnosis code for the requisition. For example, babies occasionally need testing for high bilirubin levels due to neonatal jaundice. The code for this test is 88400 (Bilirubin, total, transcutaneous) or 82247 (Bilirubin; total). Use diagnosis code 774.6 (Unspecified fetal and neonatal jaundice) when ordering this test.

Pediatricians may be put in a difficult position when adoptive parents are at the hospital, having not taken custody of the baby but wanting tests performed. The baby is not covered under their insurance, yet they are demanding that screening tests, many of which will not be covered by the birth mother's insurance, be performed. The pediatrician can obtain a form from the hospital that the adoptive parents can sign, guaranteeing they will pay for these tests.

The pediatrician and hospital, however, still should be in accord regarding which diagnosis codes to include on the requisitions. For example, if adoptive parents request that the baby be tested for HIV, use V77.99 ( other and unspecified endocrine, nutritional, metabolic, and immunity disorders). "That's not saying that the baby has the condition; it's just a screening code," says Tom Kent, CPC, CMM, president of Kent Medical Management in Dunkirk, Md. Other codes that can be used in conjunction with screening tests for newborn adoptions include V68.9 (Encounters for administrative purposes; unspecified administrative purpose) and V70.3 (Other medical examination for administrative purposes).