Pediatric Coding Alert

Question: One of our pediatricians sees a newborn for the first time in the private practice setting. The patient has no adverse medical conditions and is being seen as a well baby within the first seven days of life. The baby was born at a hospital not affiliated with our physicians. A nonaffiliated doctor performed the initial inpatient well-baby exam. What is the proper code?


Georgia Subscriber


Answer: You can classify this post-discharge visit to assess the infant's well-being and the presence or absence of jaundice as the baby's first well check. When the baby has no problem and the pediatrician performs and documents all components of the health check, report the preventive medicine service (99381 or 99391) with V20.2 (Routine infant or child health check).

After finding an infant healthy and normal, the pediatrician would continue to provide the rest of the services associated with the first well-check visit.

Catch: Because a pediatrician from your group did not perform the hospital well exam or previously provide any services to the newborn, you should code a new patient preventive medicine service (99381, Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination ...; infant [age younger than 1 year]).

When your pediatrician performs the first well-check visit after providing hospital services to the newborn, you would instead report an established patient preventive medicine service (99391, Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination ...; infant [age younger than 1 year]).

Beware: Coding this initial visit with V20.2 may use up one of the patient's allotted number of preventive medicine services. If the infant had a minor problem, such as a feeding problem (779.3), or the mother had expressed a concern, you could report that instead with an office visit code (99201-99205, Office or other outpatient visit for the evaluation and management of a new patient ...) linked to the diagnosis reflecting the problem.