Pediatric Coding Alert

Your practice probably performs well child visits each day, but how to report them will change in 2014.

When ICD-9 becomes ICD-10 in 2014, you will not always have a simple crosswalk relationship between old codes and the new ones. Often, you’ll have more options that may require tweaking the way you document services and a coder reports it.

Check out this common routine child health check visit scenario, and discover what you’ll report after October 1, 2014.

Current way: When a patient comes in for a scheduled preventive wellness exam, you should attach V20.2 (Routine infant or child health check) to an annual visit code (99381-99385 for new patients, or 99391-99395 for established patients).

ICD-10 difference: In 2014, you’ll instead use Z00.129 (Encounter for routine child health examination without abnormal findings) to reflect the physician’s visit. If the physician did encounter abnormal findings during the visit, you’d instead report Z00.121 (Encounter for routine child health examination with abnormal findings).

Physician documentation: The key difference between Z00.129 and Z00.121 is whether the visit revealed an abnormal finding during the examination of the patient. The pediatrician must document this. For instance, the physician might examine the patient and note, "patient appears severely speech delayed," which leads to the decision to perform further testing. Note: "Abnormal findings" does not refer to a blood test, biopsy, or a test that went to pathology. Often, these significant abnormal findings would support a separate E/M visit billed with a modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) at the time of a preventive medicine visit.

Coder tips: Instead of relying on V20.2 as your catch-all annual visit diagnosis, you’ll need to examine your physician’s documentation. In other words, you will be looking at the examination part of the visit and what the pediatrician notes as his findings.