Pediatric Coding Alert

Question: One of our pediatricians provided telemedicine counseling for parents who had questions about sending their child to daycare during the pandemic. The child had no symptoms and had not been tested — the parents were simply asking the pediatrician’s opinion of the safety or the potential risk of sending the children to school.

We billed using Z71.9 as the diagnosis, but Blue Cross Blue Shield (BCBS) denied, saying that this is a specialty-based ICD-10 code. Is there such a thing? And if so, what code should we use in our appeal?

AAPC Forum Participant

Answer: While BCBS may regard Z71.9 (Counseling, unspecified) as specialty-specific, ICD-10 lists no such restriction for assigning this, or any other, diagnosis code. So, this denial is, in all likelihood, is a BCBS coverage policy limiting counseling to a certain type of provider.

You might consider refiling the claim using another code: Z71.89 (Other specified counseling). The code may be more appropriate in this situation as you have specified the counseling.

In any case, you will need to clarify the reason for the denial with BCBS. And if they ultimately do not cover this benefit, you may have to make the parents responsible for the charges.