Pediatric Coding Alert

Question: An established patient who was about to undergo a bronchoscopy presented to our office for a pre-operative clearance exam. Which code should we report to her Medicaid insurer for this visit?

Answer: Ideally, you should report a consult code from the 99241- 99245 series for the visit. However, starting in 2010, Medicare discontinued recognition of the consult codes, which pay 40 percent more than other E/M codes that have comparable levels of history, physical exam and medical decision-making. If your Medicaid provider is following this policy, then use an E/M code (99201- 99215) for the visit and the appropriate V code for the preop Exam (V72.81-V72.85) and the reason for the surgery as the secondary code.

For instance, you might report 99213 for the visit, linked to V72.83 (Other specified preoperative examination) and 786.7 (Abnormal chest sounds) as the diagnosis codes.