Pediatric Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: How should we code for a follow-up visit for a 2-week-old baby? We have been using the worried well V65.5 code. However, the insurance companies are not paying, or, if they do pay, this counts as one of the check-ups for the baby. This makes the parents furious because it results in one non-payment on a check-up later in the first year of life.

Idaho Subscriber


Answer: The two-week visit is usually coded with the V20.2 (routine infant or child health check) for a well child and should be included in the normal first-year schedule of physicals as recommended by the American Academy of Pediatrics (AAP). If a major insurer in your area is not recognizing enough physicals, you should request their schedule of approved physical dates. If the insurers list differs from that recommended by the AAP, report the insurer to the AAP, which will follow up on your behalf.

Some practices have trouble with reimbursement on a three- or four-day visit for newborns discharged 24 hours after birth. In this case, it is recommended that you use office-visit codes 99212-99215 for this three- or four-day visit. Use any problems the infant has as the diagnosis. If the child is well, use V29.8 (observation and evaluation of newborns and infants for suspected condition not found; observation for other specified suspected condition) and do not use V20.2. In most cases, the other condition you are looking for is jaundice. You can use this same method for the two-week visit if necessary.