Pediatric Coding Alert

Question: One of our payers suddenly began questioning claims that we submit which have V20.2 (Routine infant or child health check) listed as the diagnosis code when billed with vaccines. This insurer is insisting that we itemize the diagnoses to match their immunizations. Should we appeal, or is this legit?

Connecticut Subscriber

Answer: The definitive answer depends on your contract with your insurer, but the American Academy of Pediatrics does note on its Vaccine Coding Table that such requests are possible during well-child checks (http://practice.aap.org/content.aspx?aid=2334).

The AAP's Table notes, "ICD-9-CM guidelines indicate that immunizations administered as part of a routine well-baby or well-child check should be reported with code V20.2. The codes listed in this table can be reported in addition to V20.2 if specific payers request them. Immunizations administered in encounters other than those for a routine well-baby or well-child check should be reported only with the codes listed in this table."

Therefore, if your payer specifically requests individual diagnoses linked to each vaccine administered during a well-child visit, refer to the AAP's table. For instance, a live MMR vaccine (90707) would be billed with V06.4 (Need for prophylactic vaccination with measles-mumps-rubella [MMR] vaccine).