Pediatric Coding Alert

Question: Our pediatrician has several patients who are about to transition from pediatric care to adult care and I’m trying to plan for their transition counseling appointments. Which counseling codes will apply for these encounters?

Delaware Subscriber

Answer: There is a specific ICD-10 code for this type of encounter, which is Z71.87 (Encounter for pediatric-to-adult transition counseling). ICD-10 Official Guidelines include instructions on how to use it: the code “should be assigned when pediatric-to-adult transition counseling is the sole reason for the encounter or when this counseling is provided in addition to other services, such as treatment of a chronic condition.”

The encounters themselves can be quite comprehensive, potentially including discussions of everything from physical activity post-formal physical education to sexuality to relationship and family issues.

Remember: You’ll need to report the provider’s time with the patient, so depending on when this transition occurs, the codes best suited for such a service would be the preventive service codes. For many adolescent patients, that would happen during their final preventive medicine visit with their pediatrician.

Turn to the following:

• 99384/94 (Initial/periodic comprehensive preventive medicine evaluation/reevaluation and management of an individual …; age 12 through 17 years)
• 99385/95 (… 18-39 years)

It should also be noted that where Z71.87 needs to fall on the claim depends on the circumstances surrounding the treatment, because the rules for applying the condition codes are unique to the patient, according to section I.C.21.c.10 of the guidelines.