Pediatric Coding Alert

Beware: Payers may force you to use 'acceptable' dxIf you've been struggling with when to use V20.2 with preventive medicine associated services, ICD-9 has one simple answer."Coding Guidelines and Coding Clinic have both said that only the V20.2 (Routine infant or child health check) code applies to vaccines and other supplemental screening exams that are done as part of a well child exam," says Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine, Department of Pediatrics at Children's Healthcare of Atlanta at Egleston. That means, you're generally going to use V20.2 as the primary diagnosis code for any services associated with a well child exam (99381-99384 for new and 99391-99394 for established patients through 17 years)."According to ICD, V20.2 is used for all developmental testing, age appropriate immunizations and routine vision and hearing testing," Linzer stresses. Here's how it works.What Dx Should You Use for Screenings?"Coding Clinic (1Q 2004, pp.14-15) clarified to use V20.2 as the diagnosis code when vision and hearing screening was part of the routine well child exam," Linzer says.Example: A pediatrician performs vision and hearing screens at a 4-year-old established patient's preventive medicine service. You would code 99392 (Periodic comprehensive preventive medicine reevaluation and management of an individual ...; early childhood [age 1 through 4 years]), 99173 (Screening test of visual acuity, quantitative, bilateral) and 92551 (Screening test, pure tone, air only), all linked to V20.2.If your office does visual evoked potential testing for amblyopia, you would similarly use V20.2 with 95930 (Visual evoked potential [VEP] testing central nervous system, checkerboard or flash), Linzer adds. "V80.2 (Special screening for other eye conditions) could be listed as an additional code."Good news: Florida Blue Cross Blue Shield has gotten onboard with paying 95930 with V20.2, reports Diane C. Fulton, director of insurance/medical coding and billing for Diopsys Inc. in Pine Brook, N.J. Prior to this policy change, Aetna was the main insurer that paid 95930 with V20.2.Is There a V20.2-With-96110 Alternative?Have you weighed V79.3 (Special screening for developmental handicaps in early childhood) as an option for 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report))? "Remember, V79.3 is an excluded code from V20.2," Linzer points out.Right way: If the physician performs the developmental screening as part of the well child exam, you would link it to V20.2, Linzer says. "If the pediatrician gave the testing for a specific reason, such as expressive language disorder (315.31), during the well child exam, then V79.3 could be used as a secondary code."Should Toxoid, Admin V Codes Match?When you're tying an immunization administration code to a specific vaccine to avoid [...]