Pediatric Coding Alert

Question: Our pediatric office wants to put together a procedure for clearing patients post-COVID infections for participation in exercise and sports. How would you suggest we code for this?

New Jersey Subscriber

Answer: You can handle patients in this situation in three different ways:

1) If the patient has no chief complaint and has fully recovered from the virus, you can clear the patient for sports by using an age-appropriate annual wellness exam from 99381-99396 (Initial/periodic comprehensive preventive medicine evaluation/ reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/ anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new/ established patient …) as an opportunity to fill out the appropriate paperwork. The information revealed by the age-appropriate history and exam that are component parts of these services would be sufficient to prove that the patient is now able to return to their chosen activity.

2) Your pediatrician could also authorize the release through a follow-up sick visit, using the history and exam portion of  the service to indicate the patient is able to return to sports. Assuming the patient is established, you could code this as 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making …) based on a self-limited problem and minimal or no data to be reviewed.

3) Your pediatrician could also perform a sports physical using 99429 (Unlisted preventive medicine service). However, unlike the other codes, 99429 carries 0 work relative value units (RVUs) and, thus, has $0 value. This means your practice would have to charge the patient for the service, which also means you will have to be upfront with the patient that you will be doing that.