Primary Care Coding Alert

Do diagnosis coding choices for your FP's preventive medicine services drive you batty?

Turns out there's a one-stop solution for ICD-9 coding for a preventive medicine service with screenings or immunization administration -- V20.2 for all. Save time assigning V codes by checking out these case studies.

When the FP performs screenings during a periodic well-child visit, you'll typically append V20.2 (Routine infant or child health check) as the primary diagnosis for all the services, confirms Jeffrey Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance at Emergency Pediatric Group Children's Healthcare of Atlanta at Egleston.

Under the descriptor, there is a list of services you should code with V20.2 -- as well as other coding instructions, such as "excludes special screening for developmental handicaps [V79.3]."

Example: A 10-year-old established patient receives a well-child exam, pure tone air test, and visual acuity test in the same session. On the claim, Linzer says you would report the following:

• 99393 (Periodic comprehensive preventive medicine reevaluation and management ... late childhood [age 5 through 11 years]) for the exam

• 92551 (Screening test, pure tone, air only) for the air test

• 99173 (Screening test of visual acuity, quantitative, bilateral) for the vision test

• V20.2 appended to all three CPT codes to explain the purpose of the tests.

If the FP provides vaccinations during a well-child visit, you usually use V20.2 for all the procedure codes -- but you should rely on different diagnoses for the vaccine supply, explains Linzer.

Example: A 10-year-old established patient received a well-child exam, and tetanus and preservative-free flu immunizations -- both done via intramuscular injection.

On the claim, report the following:

• 99393 for the exam

• 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]) for the flu vaccine administration

• +90472 ( ... each additional vaccine [single or combination vaccine/toxoid] [List separately in addition to code for primary procedure]) for the tetanus vaccine administration

• V20.2 appended to all three procedure codes to explain the services' purpose

• 90703 (Tetanus toxoid adsorbed, for intramuscular use) for the tetanus shot supply with V03.7 (Need for prophylactic vaccination and inoculation against bacterial diseases; tetanus toxoid alone) appended

• 90656 (Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use) for the flu shot supply with V04.81 (Need for prophylactic vaccination and inoculation against certain viral diseases; influenza) appended.