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Pediatric Coding Alert

Reader Questions:
Avoid 99211 for MD Weight Loss Evaluation

Question: A mother brought an infant in three days after a hospital delivery for a nurse visit with weight check and quick screen for feeding, sleep and stool patterns. The weight check showed considerable weight loss, at which time the mother complained of sore nipples and difficulty latching on. The patient and mother were triaged to the pediatrician, who performed the newborn's hospital discharge. Should I bill a nurse visit and an office visit? Illinois Subscriber Answer: No. You should bill a nurse visit (99211, Office or other outpatient visit for the E/M of an established patient, that may not require the presence of a physician; usually the presenting problem[s] are minimal; typically 5 minutes are spend performing or supervising these services) only if the patient is not triaged to the pediatrician. Because the nurse's weight check revealed persistent problems that based on protocol warranted the pediatrician evaluating the patient, you should instead bill for a follow-up visit with 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...). Watch out: If your group had not previously treated the infant in any location, you would use the new patient office visit codes (99201-99205, Office or other outpatient visit for the evaluation and management of a new patient ...). Link the office visit code to the infant's problem(s). Some applicable ICD-9 codes you can report for the baby include: • 783.21 -- Weight loss • 779.3 -- Feeding problem or vomiting, newborn.