Pediatric Coding Alert

Keep these tips in mind as you report your services.

Although most practices report a smooth ICD-10 transition, chances are strong that you have encountered a few road bumps since Oct. 1 that have stalled your pediatric practice’s claims.

To that end, Pediatric Coding Alert compiled three of the most common ICD-10 questions submitted to our editors, so read on for the expert advice on how you should code these services under ICD-10.

Aftercare Points to One Code

Question: Our pediatricians sometimes see patients for follow-up visits after evaluating a problem that required no treatment, and we are unsure of which ICD-10 code to report for these. Although Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm) is close, we’d rather have a follow-up code that describes a service that was not “after treatment.” Can you advise on whether there is such a code?

Answer: There is not such a code in ICD-10, and you are correct in selecting Z09 as the most accurate code for this service, says Donelle Holle, RN, practice administrator with Fort Wayne Pediatrics and President of Peds Coding, Inc.

Although the code’s descriptor does say “after completed treatment,” remember that “treatment” can include supportive care, such as fluids, ibuprofen, rest, and monitoring. If you are checking in on a patient who had a bout of vomiting and you want to make sure she’s feeling better following a previous visit during which the pediatrician only prescribed rest and monitoring, you can use Z09.

Payers Vary on Vision Screening Diagnoses

Question: We used to report V20.2 under ICD-9 for vision screenings, but now there are more specific codes—unfortunately there are so many that we don’t know which to use. The three most likely codes are Z13.5 (Encounter for screening of eye and ear disorders), Z01.00 (Encounter for examination of eyes and vision without abnormal findings and Z01.01 (Encounter for examination of eyes and vision with abnormal findings). Which do you recommend for standard vision screenings?

Answer: Fortunately, some payers will cover all three of these codes. For example, Aetna’s policy notes that it will reimburse for vision screenings (99174) linked with nearly a dozen ICD-10 codes, including Z01.00, Z01.01 and Z13.5, among others.

Blue Cross Blue Shield of Alabama, on the other hand, says that you can report the vision screening codes (99173-99174) along with Z01.00 or Z01.01 in patients up to age 10. For patients in the 11 to 21 age range, this payer recommends general child examination codes Z00.129, Z00.121, Z00.110 or Z00.111 instead.

Therefore, you should first check your payer policy on vision screenings to find out which the payer prefers. If, like Aetna, your insurer allows you to report any of the code options suggested in this question, show the codes to the treating pediatrician and ask her to select the code that most closely describes the reason she performed the screening.

PKU Screening Requires ‘Z’ Code

Question: We always performed our phenylketonuria (PKU) screens and billed 84030 for the test along with V77.3 (Special screening for endocrine, nutritional, metabolic, and immunity disorders; phenylketonuria [PKU]) under ICD-9. We searched our ICD-10 manual for a PKU screening code and came up with about a dozen options, but most were in the E70 series, which sound like active diseases. Can you help narrow down how to code a PKU screen under ICD-10?

Answer: You are correct in using 84030 (Phenylalanine [PKU], blood) for this service, and you will link it with Z13.228 (Encounter for screening for other metabolic disorders) under ICD-10. Although most coders were led to believe that ICD-10 is much more specific than ICD-9, in cases like PKU screens, you went from having a specific PKU screen code under the old coding system to having to use a more general code under ICD-10.

You are correct to avoid codes like E70.1 (Other hyperphenylalaninemias) because this code indicates the patient has an active PKU diagnosis, which is not the case for a screening.