Pediatric Coding Alert

Question: I have a new patient that is four days old presenting to our office with a chief complaint of jaundice. The pediatrician evaluated the patient and did not find any jaundice. He coded a 99203 with a diagnosis of V20.32. Should this be coded as a 99381 with the V20.32 or should we keep it the 99203 if documentation supports that high of a level?

Kansas subscriber

Answer: You can only report the new patient well visit code 99381 (Initial comprehensive preventive medicine evaluation and management...) if the physician did an initial physical exam with newborn anticipatory guidance and checked the birth history.

If the doctor had already seen the patient in the hospital and then saw the patient again in the office to follow up on jaundice that he had diagnosed in the hospital, you should report 99213. You'd use the established patient code since the doctor already saw the patient in the hospital.

If, however, the attending doctor in the hospital saw the baby for her first newborn visit and diagnosed her with jaundice, and your doctor is seeing the patient for the first time to follow up on the jaundice diagnosis, you can report 99203 to represent that he saw a new patient.

Consider using the newborn jaundice code 774.6 with V29.8 as the second code (Observation of newborn for condition not found).  

In general, it is better to avoid the preventive medicine code for an initial newborn visit during the first week of life. Many plans have a limited number of preventive medicine visits allowed during the first year or two of life. Using the 99381 or 99391 for this initial visit could result in being one covered preventive medicine visit short later.