Wiki Well visit Dx codes

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mamabird52803

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I am a newly certified coder but have been coding ED for about 2yrs. Recently I started a new job at a billing company and one of their main(biggest) accounts is with pediatrics. My question is regarding well baby visits. If the baby(5 day old new pt. and a 1month old est.pt.) is just brought in for a weight check only, what is the appropriate dx code? The 5 day old new patient was coded 99202 and just said weight check so, I would think it's V20.2. But, the est.pt. was coded a 99214 and just said weight check. Instead of a well visit I want to use V67.9(follow up). Since most insurance companies only cover 1 well visit per year. But, a follow up to what? Is there a primary code I can use in addition with the Vcode? Or should I request notes to see if these weight checks have anything to do with low birth weight,malnutrition etc.?

I would appreciate all that can help!!!

Erica Barden, CPC NY
 
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Just a comment on the one well visit per year - when I worked for insurance companies, that applied to older children and adults, but up to age 2 we covered more well visits per year, based on the policy (different employers could purchase different wellness benefits). So, I would check with the insurance company about how many well visits are covered for infants and children, as each one is different.
 
There is a further breakdown on well child diagnosis codes based on age:

V20.31 Under 8 days old
V20.32 8 to 28 days old
V20.2 Over 28 days old
V70.0 Young Adult 18+

V20.32 is also noted to include a Newborn Weight Check
 
If the pt comes in for an IMZ and sees the MD, but ONLY receives the IMZ, do you code it as a preventative medicine code with the IMZ or is it coded as the IMZ and administration code?

What if the patient comes in for a well visit and it hasn't been a year. Does the IMZ schedule of 2-3 months for a newborn/baby remain the schedule for the preventative medicine visits for the same child?
 
If they see the doc and happen to get imms use the preventive & imms codes; if they come in just for a nurse visit for imms and don't see the doc then only code the imms w/ the admin codes.

Yes, if the child comes in for a well visit, physical, etc use the preventive code. Peds are seen at the following intervals for a general well child check: 3-5 days of life, 1 month of life, 2 months, 4 months, 6 months, 12 months, 15 months, 18 months, 24 months, 36 months. After that, they get 1 well child visit per year. Babies are seen much more frequently than the general 1 well visit per year schedule because there are many more things that need to have an eye kept on to make sure the baby is developing normally. Visits outside of the above schedule are generally sick or concerned visits and get coded as an E/M with the applicable dx code.
 
We have a number if infants on alternate vaccine schedules. In our practice they must see a provider for immunization only visits. And we bill only for the vaccine and the admin.
 
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