Pediatric Coding Alert

Question: What is the best way to code for a newborn phenylketonuria (PKU) screen performed in-office? Should we use 84030? And is Z13.228 the correct ICD-10 code to use to accompany the screen?

Tennessee Subscriber

Answer: You could use 84030 (Phenylalanine [PKU], blood) to perform a newborn PKU screen. However, American Academy of Pediatrics (AAP) Bright Futures recommends running a full newborn metabolic screen using S3620 (Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-D; phenylanine (PKU); and thyroxine, total)) “if you are billing for the actual running of the laboratory test or test kit,” or a venipuncture code such as 36416 (Collection of capillary blood specimen (eg, finger, heel, ear stick)) if you are just collecting the blood sample to send out for the test.

AAP also recommends Z13.228 (Encounter for screening for other metabolic disorders), Z13.0 (Encounter for screening for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism), Z13.21 (Encounter for screening for nutritional disorder), or Z13.29 (Encounter for screening for other suspected endocrine disorder) to accompany S3620/36416.

The actual choice of code will depend on “the state-specific newborn screening tests conducted,” according to AAP. So, you and your provider should determine which test best meets your state guidelines and which ICD-10 code best accompanies that test.

(Source: Coding for Pediatric Preventive Care, 2019, www.aap.org/en-us/Documents/coding_preventive_care.pdf)