Pediatric Coding Alert

Question: One of our payers suddenly began questioning claims that we submit which have V20.2 (Routine infant or child health check) listed as the diagnosis code when billed with vaccines. This insurer is insisting that we itemize the diagnoses to match their immunizations. Should we appeal, or is this legit?Connecticut SubscriberAnswer: The definitive answer depends on your contract with your insurer, but the American Academy of Pediatrics does note on its Vaccine Coding Table that such requests are possible during well-child checks (http://practice.aap.org/content.aspx?aid=2334).The AAP's Table notes, "ICD-9-CM guidelines indicate that immunizations administered as part of a routine well-baby or well-child check should be reported with code V20.2. The codes listed in this table can be reported in addition to V20.2 if specific payers request them. Immunizations administered in encounters other than those for a routine well-baby or well-child check should be reported only with the codes listed in this [...]