Pediatric Coding Alert

Question: The number of codes necessary for first-year well visits seems excessive. How, for example, am I to code an eight-week checkup with four vaccines? Theres no room on the claim form!

California Subscriber

Answer: Although combination vaccines are coming out as fast as the Food and Drug Administration can approve them, so too are new individual vaccines. The problem you mention is here to stay.

An eight-week checkup includes the well visit itself (99391), DTaP (90700), the DTaP administration (90471), HIB (90647), the HIB administration (90472), IPV (90713), the IPV administration fee (90472), Prevnar (90669) and the Prevnar administration (90472). Bill the visit, with linked diagnosis codes, as follows:

99391-V20.2
90700-V06.1
90471-V06.1
90647-V03.81
90472-V03.81
90713-V04.0
90472-V04.0
90669-V03.89
90472-V03.89

Because you will have more than four diagnoses you will need two claim forms. Although some coders avoid multiple forms by using V20.2 (routine infant or child health check) for all immunizations, the American Academy of Pediatrics (AAP) discourages this because the purpose of the vaccine diagnosis codes is tracking. In addition, correct coding principles dictate that you use the diagnosis code that best fits the service. The AAP recommends checking with your payer to see which method of filing it prefers, however. Some payers will only reimburse for V20.2.

V20.2 does not match with a sick visit E/M service, and therefore you may not use it if a child must be immunized at a time other than a well visit.