Guidelines for Coding Jaundice Follow-up Encounters

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4 Guidelines for Coding Jaundice Follow-up Encounters

Key: Treat 'bill checks' as sick, not well visits

You can avoid incorrectly using up one of a newborn's allotted preventive medicine services, as long as you charge an office visit, not 99391, when you see a patient for a hyperbilirubinemia and a weight check after discharge.

The American Academy of Pediatrics recommends that pediatricians examine all infants "in the first few days after discharge to assess infant well-being and the presence or absence of jaundice," to Management of Hyperbilirubinemia in the Newborn Infant 35 Weeks or More of Gestation. But many providers are unsure how to bill these visits.

Case study: Leticia Bibian, director of patient accounts at Northeast Valley Health Corp. in San Fernando, Calif., says her pediatricians see newborn babies three to five days after birth to check if the baby is feeding well, to check his weight, and determine if there is jaundice. "How would you code this type of visit?" she asks.

1. Use a Sick Visit Code

First, you should consider the above real-world coding scenario a sick visit. "Our providers say this is not a normal well-child exam," Bibian says.

The visit is to check for specific problems. "The encounter is for a follow-up of the hospital visit and to ensure the transition home has gone well," says Charles A. Scott, MD, FAAP, pediatrician at Medford Pediatric & Adolescent Medicine PA in Medford, N.J.

Solution: Report a postdischarge bilirubin/weight check with the appropriate-level office visit code (9920 1- 992 15, Office or other outpatient visit for a new or established patient ...). If the pediatricians initially saw the newborn in the hospital, code an established patient office visit (992 12-99215).

Reserve the initial well-visit code for when the parent and infant return for the "first official" well-child checkup, usually a week later. "Use V20.2 (Routine infant or child health check including immunizations appropriate for age) at that visit with 99391 (Periodic comprehensive preventive medicine re-evaluation and management of an individual including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization [s], laboratory/diagnostic procedures, established patient; infant [age under 1 year])," Scott says.

2. Report Definitive Diagnosis

The easiest ICD-9 coding option occurs when the newborn has a problem or symptom at the time of encounter. If the patient has developed jaundice, lost weight or is having feeding problems, you should report the definitive diagnosis or symptom.

Some possible ICD-9 codes include:

774.6 -- Unspecified and neonatal jaundice
779.3 -- Feeding problems in newborn
783.2l --Loss of weight
783.41 -- Failure to thrive.

Good news: You'll often be able to use one of the above-listed diagnoses for the hospital follow-up visit. "When we see the babies, very few have regained birth weight, some are jaundiced, most parents have feeding questions, etc.," Scott says.

3. Code Complaints, Birth Problems

You may also assign a diagnosis that represents the parent's complaint or the pediatrician's hospital concern. If the parent has any complaints at the time of the encounter, the physician should select a corresponding code, says Jeffrey Linzer Sr., MD, MICP, FAAP, AAP representative to the ICD-9-CM editorial advisory board. He could also report a code "based on conditions at the time of birth that may be contributing to the encounter," Linzer says.

Using these principles, the code for a "bili check" in which the pediatrician finds no jaundice may include any of the following:

530,81 -- Diseases of esophagus; other specified disorders of esophagus; esophageal reflux (can use when parent complains the newborn is spitting up)
760-763 -- Fetus or newborn affected by maternal/labor and delivery conditions/complications
779.3 -- Feeding problems in newborn
783.21 -- Loss of weight
V58.9 -- Unspecified aftercare.

(Continued on next page . . . but not included here in this critique.)

Pediatric Coding Alert/September 2005
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