Primary Care Coding Alert

Beware: Payers may force you to use -acceptable- dx 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. What Dx Should You Use for Screenings? "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." Should Toxoid, Admin V Codes Match? 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 [...]