Pediatric Coding Alert

Question: Medical Assistance (MA) started denying Minnesota's preventive medicine service plan, Child and Teen Checkups (C&TC), due to too many diagnosis codes.

Minnesota Subscriber

Answer: Because the guideline adheres to ICD-9 guidelines, you can stick to the program's requirement of reporting V20.2 (Routine infant or child health check) across the board. ICD-9 guidelines indicate that you should link the vaccines to V20.2. "A code from V03-V06 may be used as a secondary code if the inoculation is given as a routine part of preventive health care, such as a well-baby visit," according to Coding Clinic (4Q 1996, p. 50).

Let's say at a 1-year-old's C&TC with no referrals (NU), the pediatrician provides established-patient preventive medicine service (PMS), counsels on the benefits and risks associated with vaccines prior to a nurse administering state supplied vaccines (modifier SL) of HepB, DTaP, Hib, PCV7, IPV, MMR, VAR, and HepA (2 dose), and drawing blood to send to a reference lab (modifier 90) for lead screening. Per ICD-9, you would link V20.2 to each immunization product, and then you may list the specific vaccine ICD-9 code as an additional diagnosis. Since MA wants V20.2 only, you can drop this option. A partial C&TC claim form could contain one diagnosis in box 21 linked to the following services in box 24 as shown here: