Primary Care Coding Alert

If you-ve been unsure when to use V20.2 with preventive medicine associated services, ICD-9 has one simple answer.

"Coding guidelines and Coding Clinic have both said that only the V20.2 (Routine infant or child health check) code applies to vaccines and other supplemental screening exams that are done as part of a well-child exam," says Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine, Department of Pediatrics at Children's Healthcare of Atlanta at Egleston. That means you-re generally going to use V20.2 as the primary diagnosis code for any services associated with a well-child exam (99381-99384 for new and 99391-99394 for established patients through 17 years).

"According to ICD, V20.2 is used for all developmental testing, age appropriate immunizations, and routine vision and hearing testing," Linzer stresses.

Here's how it works.

"Coding Clinic (1Q 2004, pages 14-15) clarified to  use V20.2 as the diagnosis code when vision and hearing screening was part of the routine well-child exam," Linzer says.

Example: An FP performs vision and hearing screens at a 4-year-old established patient's preventive medicine service. You would code 99392 (Periodic comprehensive preventive medicine reevaluation and management of an individual ...; early childhood [age 1 through 4 years]), 99173 (Screening test of visual acuity, quantitative, bilateral), and 92551 (Screening test, pure tone, air only), all linked to V20.2.

Right way: If the physician performs developmental screening (such as 96110, Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) as part of the well-child exam, you would link it to V20.2, Linzer says. If the physician "gave the testing for a specific reason, such as expressive language disorder (315.31), during the well-child exam, then V79.3 (Special screening for mental disorders and developmental handicaps; developmental handicaps in early childhood) could be used as a secondary code."

When you-re tying an immunization administration code to a specific ICD-9 vaccine code to avoid insurers viewing multiple administrations as duplicates, you should still list V20.2 first with the vaccine CPT code, according to ICD. Coding Clinic (4Q 1996, page 50) states, "A code from V03-V06 may be used as a secondary code if the inoculation is given as a routine part of preventive health care, such as a well-baby visit."

What to do: "Based on Coding Clinic, the vaccine CPT codes should be linked to V20.2 with the vaccine ICD-9 code as an additional diagnosis," Linzer explains. You could link the vaccine administration codes (90465-90474) to the vaccine ICD-9 code.

For instance, Linzer says a claim for Tdap (90715, Tetanus, diphtheria toxoids, and acellular pertussis vaccine [Tdap], when administered to individuals 7 years or older, for intramuscular use) (V06.1, Need for prophylactic vaccination and inoculation against combinations of diseases; diphtheria-tetanus-pertussis, combined [DTP] [DTaP]) and Menactra (90734, Meningococcal conjugate vaccine, serogroups A, C, Y, and W-135 [tetravalent], for intramuscular use) (V03.89, Other specified vaccinations against single bacterial diseases; other specified vaccination) that a nurse administers (90471, +90472, Immunization administration ...) to an 11-year-old could read:

- 90715 V20.2 (V06.1 optional additional dx)

- 90471 V06.1

- 90734 V20.2 (V03.89 optional additional dx)

- 90472 V03.89.

Will You Always Follow These Guidelines?

Although ICD-9 coding requires you to report only V20.2, not all payers follow these guidelines, explains Linda Walsh, Committee on Coding and Nomenclature manager and Division of Health Care Finance and Quality improvement director for the American Academy of Pediatrics in Elk Grove Village, Ill. "Therefore, in order to be paid, many/most-physicians must utilize what we call -acceptable- (as opposed to -optimal-) coding."

Best bet: Pay attention to payer guidelines because some may require you to use V03-V06 as the primary diagnosis code for immunizations administered at a preventive medicine visit. For these payers, link V20.2 to the preventive medicine visit (99381-99395), and the appropriate V03-V06 code to the specific vaccine product (90476-90748).