Pediatric Coding Alert

Now that you have four codes for foster care or welfare situations, you've got to focus on its role in the encounter -- or you could land on the wrong V code.

To better monitor foster care, ICD-9 2010 creates V60.81 (Foster case [status]). But you should consider additional foster care codes including:

• family disruption (V61.05, Family disruption due to child in welfare custody and V61.06, Family disruption due to child in foster care or in care of non-parental family member)

• counseling codes (V61.25, Counseling for parent [guardian]-foster child problem).

Important: "I would use V60.81 more as a secondary code than a primary code," notes Donelle Holle, RN, a coding and reimbursement consultant with Pedscoding.com in Ft. Wayne, Ind. ICD-9-CM confirms this designation, which also applies to the other new V60.8x code: V60.89 (Other specified housing or economic circumstances). In contrast, V61.0x and V61.2x can be first listed or additional codes.

To choose between the foster care circumstances, family disruption, and counseling codes, pay attention to how the foster care contributes to the encounter. Here are three ways:

Circumstances: You might use the foster care status code (V60.81) if social service asks a pediatrician to see a patient who is being moved from one foster care into another foster care home and the social worker is concerned about the child's health, Holle suggests. Or you could report the code if a social services worker asks a doctor to check a child's health due to concerns about the child's home (for example, the child was removed from a home due to parental neglect).

Family disruptions: You would instead use V61.05 and V61.06 for family disruptions, which ICD-9-CM notes includes "when these circumstances or fear of them, affecting the person directly involved or others, are mentioned as the reason, justified or not, for seeking or receiving medical advice or care." "For kids in foster care, V61.05 or V61.06 can be used at each visit," says Ann S. Botash, MD, professor of pediatrics and vice chair for educational affairs for the pediatric department at SUNY Upstate Medical University in New York.

Counseling: Consider the parent-child problem code V61.25 when the pediatrician provides counseling about a problem. For instance, the parent is concerned about the foster child's behavior. You might also use V61.25 for counseling due to a parent/guardian and foster child conflict or relationship problem.