Pediatric Coding Alert

Question: Based on the American Academy of Pediatrics recommendation that pediatricians examine all infants in the first few days after discharge to assess infant well-being and the presence or absence of jaundice, I saw a newborn three days after I saw him in the hospital. I made sure the baby was feeding well, checked his weight, and determined if he had any signs of jaundice. I coded the encounter with a sick visit code. What ICD9 Codes should I use?


Georgia Subscriber

Answer: You are right to consider the scenario a sick visit. The visit is for a follow-up of the hospital visit and to ensure that the transition home has gone well. Because you saw the newborn in the hospital, you should report the postdischarge bilirubin/weight check with the appropriate-level office visit code 99212-99215 (Office or other outpatient visit for an established patient ...).

You didn’t mention whether the newborn had any problems or symptoms at the visit. If the patient had developed jaundice or lost weight or is having feeding problems, you should report the definitive diagnosis or symptom.

Some possible ICD-9 codes include:

• 774.6--Unspecified fetal and neonatal jaundice
• 779.3--Feeding problems in newborn
• 783.21--Loss of weight
• 783.41--Failure to thrive.

You may also assign a diagnosis that represents the parent’s complaint or the pediatrician’s hospital concern. If the parent has any complaints at the time of the encounter, the physician should select a corresponding code. He could also report a code based on conditions at the time of birth that may be contributing to the encounter. Using these principles, the code for a “bili check” in which the pediatrician finds no jaundice may include any of the following:

• 530.81--Diseases of esophagus; other specified disorders of esophagus; esophageal reflux (can use when parent complains the newborn is spitting up)

• 760-763--Fetus or newborn affected by maternal/labor and delivery conditions/complications

• 779.3--Feeding problems in newborn

• 783.21--Loss of weight

• V58.9--Unspecified aftercare.

You should consider two additional V codes for hospital follow-up visits in which the newborn exhibits no signs or symptoms. If you want to monitor the newborn’s continued weight gain, but the infant has not lost weight, ICD-9 offers V65.3 (Dietary surveillance and counseling). This code can also be useful for encounters in which the pediatrician counsels the parent on feeding issues.

Another possible diagnosis for a “no problem” recheck is V29.x (Observation and evaluation of newborns and infants for suspected condition not found). Code V29.8 (Observation for other specified suspected condition) would most likely apply to the evaluation of jaundice not found.