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pediatric E/M

  1. #1
    Default pediatric E/M
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    Okay, I'm new to pediatric coding. We have a physician who codes the pediatric visits with a problem focused visit, but the V20.2 codes. I'm not familiar enough with pediatric coding to determine whether this is accurate, but I'm thinking not. These are well visit codes, and to my thinking should only be used with preventive visits. But, how do you code the check up visits for infants. For instance, I have an example here, some of this is unreadable to me:

    1 month check up
    The birth history is documented, the length, wt, head circ, temp, chest, who accompanied (parents), age, date.
    Interval history injuries, illness: none
    medication: none
    Allergies: NKA
    Milestones, nutrition, formula (type, amount, how often)
    Spitting up x0, other problems none
    Sleep (bad)
    Elimination (BM 1-3 daily, void often)
    Vaccination (can't read)
    Concerns none
    examination:
    L-node okay-clear
    chest clear
    CNS S1, S2, )
    Abn
    Genitals
    Testes Low
    Head Neck
    ears
    eye
    tone
    reflexes all okay
    Then health behaviors:
    car seat, family relatonships,
    back to sleep
    second hand smoke
    immunizations
    colic
    follow up one month

    This was coded with 99203 V20.2 Would this be correct?

  2. #2
    Default
    Quote Originally Posted by Anna Weaver View Post
    Okay, I'm new to pediatric coding. We have a physician who codes the pediatric visits with a problem focused visit, but the V20.2 codes. I'm not familiar enough with pediatric coding to determine whether this is accurate, but I'm thinking not. These are well visit codes, and to my thinking should only be used with preventive visits. But, how do you code the check up visits for infants. For instance, I have an example here, some of this is unreadable to me:

    1 month check up
    The birth history is documented, the length, wt, head circ, temp, chest, who accompanied (parents), age, date.
    Interval history injuries, illness: none
    medication: none
    Allergies: NKA
    Milestones, nutrition, formula (type, amount, how often)
    Spitting up x0, other problems none
    Sleep (bad)
    Elimination (BM 1-3 daily, void often)
    Vaccination (can't read)
    Concerns none
    examination:
    L-node okay-clear
    chest clear
    CNS S1, S2, )
    Abn
    Genitals
    Testes Low
    Head Neck
    ears
    eye
    tone
    reflexes all okay
    Then health behaviors:
    car seat, family relatonships,
    back to sleep
    second hand smoke
    immunizations
    colic
    follow up one month

    This was coded with 99203 V20.2 Would this be correct?
    First, is this a new pt to the practice; it is my understanding from the documentation you've provided that this should be a well-child visit 99381-99385 if new pt, 99391-99395 if established pt.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  3. #3
    Default pediatric
    See my dilemma? It's not documented whether the child is established or not. Age 1 month. Note on progress note says-1 month check up. This group of Dr's are giving me fits. But, I'm not familiar enough with pediatrics to fight yet.
    So, I have found that in ped's that well visits are charged periodically the first year of life? Is this correct? I have read 2, 4, 6, 9 and 12 months. Someone else told me 3, 6, 9, 12 and 18. But, they also said it was carrier specific.
    So, I'm okay in thinking this code should be 99391 or 99381 (depending), with the V20.2 dx.
    Thanks for your help!

  4. Default
    Good Question!! The AAP recommends 2,4,6,9,12,15,18 exams for babies. If the physician is documenting any abnormalies that warrants an E/M code during a Preventative Visit (V202) 99381-99397. Use Mod-25 on the E/M code. Example 99391 (V202) 99213-25 (Dx?).

  5. #5
    Default
    Quote Originally Posted by Anna Weaver View Post
    See my dilemma? It's not documented whether the child is established or not. Age 1 month. Note on progress note says-1 month check up. This group of Dr's are giving me fits. But, I'm not familiar enough with pediatrics to fight yet.
    So, I have found that in ped's that well visits are charged periodically the first year of life? Is this correct? I have read 2, 4, 6, 9 and 12 months. Someone else told me 3, 6, 9, 12 and 18. But, they also said it was carrier specific.
    So, I'm okay in thinking this code should be 99391 or 99381 (depending), with the V20.2 dx.
    Thanks for your help!
    Is there anyway for you to check this pt's chart to verify if it is a new pt or not. I would atleast ask the Dr. if this is the pts first visit with this practice. Just seems like there has to be some information in the chart or within your computer system to verify this.

    You could also just copy the pages out of CPT with the New and Est Preventative visits for the Dr. to view also... that might be a good start.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  6. #6
    Default pediatric E/M
    Thanks everyone. I did find out the patient was established and am using the 99391 with the V20.2. This forum is great!!!

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