Pediatric Coding Alert

Question: We often have parents who come in wanting to get to know the pediatrician before the baby is born. How can we report these visits, since the baby isn’t present?

Answer: There are several schools of thought about how to report these “get to know the pediatrician” visits. Some practices choose to report the visit under the mother’s insurance using a preventive medicine counseling code (such as 99401-99404) linked to ICD-9 code V65.11 (Pediatric pre-birth visit for expectant parents).

If the mother or the fetus has any existing symptoms or a specific illness, you’ll report a code from the 99201-99215 series instead, since these codes more accurately describe a problem-focused visit.

If you choose to go this route, however, you should tell the family ahead of time that you’ll be billing for the visit and that they may be subject to a copay or deductible, since some parents may be surprised to pay anything for these visits. In addition, some insurers won’t reimburse you at all for these visits.

In other cases, it’s possible that the ob-gyn has identified a problem with the fetus and has asked for your opinion. For insurers that still accept consultation codes (99241-99245, Office consultation for a new or established patient ...), you can report the appropriate code from this range with a written report back to the ob-gyn if the ob refers the patient to you and asks you to meet with the patient. This consultation would again be billed under the mother’s insurance if the baby is still in utero.

Some pediatricians simply consider doing meet-and-greets as good public relations (PR) and consider them a practice builder, since these visits could lead to the patient joining your practice. This may be partially determined by how competitive your practice environment is..