Wiki Help!

[LADY_SETSUNA_CJ]

I work in a pediatrics office. We recently saw a 5 week old patient for her 1 month well visit. Which was coded as a 99391 V20.2, 648.40 (post-partum depression) as a suspected dx - which is not a covered code due to patients age. We explained to the provider we cannot bill this code due to the fact it is a maternal code and cannot be used for the baby, not to mention we cannot bill suspected dx codes. The doctor responded stating that he will addendum the code from the chart but that he wanted another code that could be used for this child since this directly affects the childs clinical care.

Upon review of the chart I cannot find anything to code for the child. The only notes pertaining to the post-partum depression or the effect on the child would be 'Improving. Mom is back on Abilify. Long discussion. The MGM will play a considerable role.' The remaining documentation discusses the childs adaptation to the home, family status, appropriate safty measures in baby proofing the home, feeding, and patients sleep habits.

So the question is what code would be appropriate for this situation?

Any help would be greatly appreciated.

 

[LindaEV]

I am not seeing the necessity of another diagnosis. V20.2 is sufficient to get the claim paid. Discussing what is going on at home, is kind of part of the whole preventative service. Adding an additional dx is not going to get any more money or a higher level as if it were a regualr office visit.
I guess I am just not understanding why he thinks this is so improtant.

 

[LADY_SETSUNA_CJ]

I'm aware the additional dx is not necessary for payment nor will it add additonal payment. I'm sure the provider knows this as well. Other than documentation purposes to show the effects the post-partum is having on the child, there is no need for the dx on the claim. This seems to be important to our provider for the information be on the claim. I'm just trying to find out if there is an appropriate code for it, if for nothing more than to satisfy my provider.