Pediatric Coding Alert

Question: An 18-year-old established patient met with our pediatrician to discuss an upcoming trip to Africa and what medications/vaccines the patient may need to prepare for the trip. I am thinking 99213 based on time. What diagnosis should I use?

Georgia Subscriber

Answer: The ICD-9 code choice is the easy part. Use V65.49 (Other specified counseling).

For the CPT code, you could use an office code based on time, provided counseling and/or coordination of care comprises more than 50 percent of the physician-patient face-to-face time, and the documentation supports timebased coding. An office visit code, however, is problemoriented, and the insurer might kick out 99213 (Office or other outpatient visit for the evaluation and management of an established patient ... Physicians typically spend 15 minutes face-to-face with the patient and/or family), for instance, with a well V code.

Option: If the insurer accepts the preventive counseling codes, a travel clinic is the perfect opportunity to use 99401 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes) or 99402 (... approximately 30 minutes). Since the pediatrician is providing counseling to promote health and prevent illness, the preventive medicine counseling/risk factor reduction codes describe the service.

You could also report 99401 or 99402 incident to the pediatrician if your office has a nurse provide the counseling. The physician should be in the office to supervise the service and to meet Medicare's incident-to criteria, which most private payers adopt.