Pediatric Coding Alert

Once you've answered the quiz questions on page 68, compare your answers with the ones our experts have provided below:

Answer 1:
Code Z00.129. As this encounter functions as both a check-up and school physical, and the exam uncovered no abnormal findings, you would code Z00.129 for the evaluation and management (E/M) service. This code is preferable to Z02.0 because Z02 codes are an Excludes1 for Z00.129, according to ICD-10-CM guidelines.

Answer 2:
Yes. As Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania, explains: "it is appropriate to bill separately for this as the CPT^® guidelines in the Preventive Medicine Services section state that '... screening tests identified with specific CPT^® codes are reported separately.'" But she also goes on to caution that "the payer you are dealing with may have a specific policy in place that says otherwise."

This view is echoed by Donelle Holle, RN, President of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana, who goes on to say that "because some carriers may not cover screenings, it is important to inform the patients of the importance of them and let them know that the screenings may not be paid and they may or may not be responsible."

Answer 3:
Code 90460. You would code 90460 as, according to Falbo, you would only "report code 90471 for immunization of any vaccine that is not accompanied by face-to-face physician or other qualified healthcare counseling for the patient and/or family or for patients over 18 years of age."

Answer 4:
No. When you code for these immunizations, in addition to reporting 90710 (Measles, mumps, rubella, and varicella vaccine [MMRV], live, for subcutaneous use), and 90713 (Poliovirus vaccine, inactivated [IPV], for subcutaneous or intramuscular use) for the immunizations, you will document for the vaccine administration using 90460 and 90461. However, as Falbo notes, "90461 is an add-on code reported for each additional vaccine component administered." So, payers will only reimburse you for 90461 if it is reported together with 90460, which is the primary code for vaccine administration.