Pediatric Coding Alert

Your preventive medicine services' diagnosis list is about to expand. Prepare your charge ticket -- and your staff -- for this major pediatric ICD-9 shift.

When ICD-9 2010 becomes effective on Oct. 1,you'll welcome broader hazardous history of and pediatric birth visit codes. These changes answer some of your top questions.

You've always turned to V20.2 as your go-to-preventive-medicine-services' ICD-9 linkage. When insurers accept ICD-9 2010 codes, you'll have two more choices:

• V20.31 -- Health supervision for newborn under 8 days old

• V30.32 -- Health supervision for newborn 8 to 28 days old.

Use these codes for well-newborn exams, preferably known as infant preventive medicine services (99381 for a baby that you or a copediatrician have not seen or treated or 99391 for a newborn who has been examined by you or your coworkers). "I would hesitate to use V20.31" for the newborn post-hospital follow-up visit that is typically performed around day 5, says Donelle Holle, RN, a coding and reimbursement consultant with Pedscoding.com in Fort Wayne, Ind. Carriers will no doubt consider the V code diagnosis to be a "well-child exam."

Disappointing: The V code's introduction isn't your ticket to better 99381, 99391 (Preventive medicine services, infant [age younger than 1 year]) coverage."There still remains the problem of using too many 99391 codes in the first year of life," points out Charles Scott, MD, FAAP, a pediatrician at Medford Pediatric and Adolescent Medicine in New Jersey.

If you're trying to catch a patient up on her immunizations, you can soon use the new personal history of underimmunization code:

• V15.83 -- Personal history of underimmunization status.

Reality: Some parents limit the number of vaccines that they'll allow their child to receive at one visit. So a patient might be receiving a vaccine at eight months of age that they normally would have received at six months, Holle relates. "You could use V15.83 to help justify why you are doing this vaccine at this time."

Finding the ICD-9 code for a lead screen due to possible exposure has always been a little tricky. The V code's revised language makes its purpose much clearer. V15.86 will refer to "personal history of contact with and (possible) exposure to lead," rather than the more definitive sounding "exposure to lead."

Example: A mom brings a child in for lead testing relating that she thinks she's been playing with a toy that was recalled for lead-based paint. You don't need proof that the toy was contaminated to use V15.86 for either exposure to lead or possible lead exposure.

Watch out: Reserve V15.86 as a secondary diagnosis to support the medical necessity for doing a lead screening (V82.5, Special screening for other conditions; chemical poisoning and other contamination). ICD-9 2009's V Code Table indicates V15.86 as an additional diagnosisonly code (Coding Guidelines, page 19).

The exposure to asbestos code (V15.84) and exposure to potentially hazardous body fluids code (V15.85) will undergo similar language changes.

To be more politically correct, the pediatric pre-birth visit for expectant mother code V65.11 will reflect expectant parent(s), rather than specifying the pregnant party (the mother). This descriptor change will be more reflective of society changes in the composition of families to include adoptive parents, same-sex partners, fathers, etc.,notes a pediatric coder in South Dakota. The new code will read "Pediatric pre-birth visit for expectant parent(s)."

Impact: A dad comes in to check out your practice before his wife has a baby. You could use V65.11 when ICD-9 2010 codes go into effect.

View a complete list of the new and revised ICD-9 2010 codes at www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp.