Pediatric Coding Alert

Question: Our provider saw a 6-year-old patient for a 99393 well-child check. At the encounter, the physician administered a hemoglobin check, which came back normal. However, during the exam, the doctor noticed that the child was wheezing, and the child’s mother noted that there was a family history of asthma and other respiratory diseases. Should I code the hemoglobin test along with Z00.129 and the wheezing with Z00.121? Or does everything go under the Z00.121 since there was an abnormal finding?

Wisconsin Subscriber

Answer: You would never code Z00.129 (Encounter for routine child health examination without abnormal findings) with Z00.121 (Encounter for routine child health examination with abnormal findings) on the same chart. Simply put, either the child is well at the time of the visit or he or she is not.

In this case, you would code 99393 (Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late childhood (age 5 through 11 years)) along with Z00.121, as your pediatrician documented an abnormal finding during the preventive evaluation and management (E/M) encounter.

You would also code the wheezing with a signs and symptoms code such as R06.2 (Wheezing) pending further testing. And it would be perfectly acceptable to add a code such as 85018 (Blood count; hemoglobin (Hgb)) for the hemoglobin check to Z00.121, even though that particular test revealed nothing abnormal.

Remember to bill for the sick visit. In this circumstance, don’t forget that you can report a problem-oriented E/M service from 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …). While CPT^® guidelines state that an “insignificant or trivial problem/abnormality that is encountered in the process of performing the preventive medicine evaluation and management service and which does not require additional work and the performance of the key components of a problem-oriented E/M service should not be reported,” you can bill for a sick visit if your pediatrician uncovers a significant problem. But you’ll have to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to show that the sick visit was distinct from the preventive medicine visit.