Pediatric Coding Alert

Question: We recently have had portions of our claims denied. A child is seen for a one-year preventive visit, and we use code 99391 with a diagnosis of V20.2 (routine infant or child health check). If this child receives immunizations at the same time, should a different code be used (99213 or 99214) instead of 99391? The diagnosis for the visit would be V20.2 with additional CPT and diagnosis codes for the immunizations. If we use 99211 for a child returning for immunizations for a previous well visit (using preventive codes), would we use V20.2 for the diagnosis for 99211 and the additional CPT and diagnosis codes for the immunizations?

Janet LaBarge
Kids Korner Pediatric Center, Massena, N.Y.

Answer: You are appropriately coding the visit for a well-child visit for a child who is well, by using 99391. If, during the course of the well visit, the provider discovers an illness that is documented and treated, then you would use a separate evaluation and management (E/M) code such as 99213 or 99214, depending on the severity of the illness. Be sure to use a modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) on the office visit as well.

Regarding immunizations, always use the appropriate CPT immunization code and an administration code as well. Use the proper ICD-9 code for each specific immunization. If a child must return for immunizations for some reason, then 99211 is appropriate to code. As far as the diagnosis code to be used, if the reason the child is returning is because of an illness that prohibited the immunizations at a previous visit, you could use the diagnosis for the condition to be checked for the visit, and the appropriate codes for the immunizations.

Answers to Reader Questions and You Be the Coder provided by Victoria Jackson, chairwoman, Pediatric Task Force Committee of the Medical Group Management Association; Mark S. Reuben, MD, FAAP, president, Reading Pediatrics, a private eight-pediatrician practice in Wyomissing, Pa.; Thomas Kent, CMM, president of Kent Medical Management, a practice management and coding consulting firm in Dunkirk, Md.; Richard H. Tuck, MD, FAAP, founding chairman of the AAPs coding and reimbursement committee, pediatrician at PrimeCare of Southeastern Ohio.