Primary Care Coding Alert

Question: BlueCross National Capital Area (NCA) started applying claims containing V20.2 as other than well care. The insurer blames the denials on incorrect coding. The representative explained, -They know there is another code for well care, but they do not know what it is.- Does ICD-9 include another diagnosis that I should use?


Maryland Subscriber

Answer: The insurer could want you to use the adult preventive service examination code V70.0 (General medical examination; routine general medical examination at a healthcare facility). Per ICD-9, 18 years is the usual cut-off age for the infant and child health check-up V code (V20.2, Health supervision of infant or child; routine infant or child health check).

Support: The Additional Conventions section of the AMA-s ICD-9-CM Volumes 1 and 2 designates V20.2 as a pediatric diagnosis for ages 0-17. The yellow square P following V20.2 indicates, -These diagnoses are intended for children, and the patient's age must [be] between 0 and 17 years,- according to the Age and Sex Edit Symbols subsection on page 6.

Implication: You should use V20.2 with infant (age under 1 year) through adolescent (age 12 through 17 years) preventive medicine service codes (99381-99384, Initial comprehensive preventive medicine evaluation and management of an individual ...; and 99391-99394, Periodic comprehensive preventive medicine re-evaluation and management of an individual ...).
 
Switch to V70.0 when a patient who is 18 or older presents for a well-check (99385-99387, New patient preventive medicine service; and 99395-99397, Established patient preventive medicine service).

Hitch: Insurers may have different age guidelines. For instance, Mississippi Medicaid indicates that coders should use V20.2 until a beneficiary is 21 years old. Other payers want physicians to switch from V20.2 to V70.0 when a patient turns age 5.

Best bet: Contact your representative again and ask him to send you a letter or e-mail stating at what age BlueCross NCA wants you to start using V70.0. Explain that ICD-9 indicates V20.2 is a pediatric code and that you-d be happy to comply with contradictory guidelines if  he supplies you with an alternative written policy to follow.