Correct Coding Is Key to Getting Paid for Meetings with Adoptive Parents
Published on Mon Nov 01, 1999
There are some CPT and ICD-9 coding and reimbursement challenges inherent when meeting with parents who are thinking about adoption. But there are also answers, including consultation codes, team conference codes, and billing parents directly.
When pediatricians meet with parents who are thinking of adopting a child, the meeting generally falls into one of two categories: Its either with parents who want to adopt, but havent settled on a particular child, or its with parents who have picked a child and have questions about the childs health, parenting issues, etc.
If the child is from a foreign country, the parents may want the pediatrician to review videotapes or adoption agency notes. If the child is in foster care in this country but has health problems, the parents will want to discuss this at length with the childs future pediatrician.
Using Consultation Codes
Sandy Farrell, insurance and billing manager for Alpharetta Pediatrics, based in Roswell, GA, uses consultation codes (99241-99245) for pre-adoption interviews when parents havent decided on a child yet. For the diagnosis code, she uses V68.89 (encounters for administrative purposes; other specified administrative purpose; other). Although most ICD-9 books dont mention it, this code is usually recognized by insurance companies as being specifically for adoption administrative purposes. If the meeting is about a specific child, but the child isnt presentfor example, the parents are showing photographs to the doctor for an assessmentthen Farrell would still use a consultation code.
Team Conference Codes Worth a Try
Another option is the team conference codes (99361, medical conference with interdisciplinary team of health professionals; approximately 30 minutes; and 99362, approximately 60 minutes). Sue Wilson, CPC, business office supervisor for Phoenix Pediatrics in Glendale, AZ, uses these codes instead of the consultation codes. Most of the meetings with parents at Wilsons practice involve children who have already been selected for adoption. Theyre not foreignrather, many are in foster care. They involve a lot of different people, she says. Theres someone from the adoption agency, theres a care giver (because often these children have health problems), and there are the prospective parents, she says. I called our insurance companies and secured pre-approval to code with the team conference codes.
The diagnosis coding is a bit different from foreign adoptions because these are children whose medical histories are known. Unfortunately, a lot of these cases involve a child with a handicap of some kind, Wilson says. So, when the childs history is available, you would use whatever diagnosis code is appropriate for the childs medical problem when you have the team [...]
