Pediatric well visits are super important for children as they get bigger to ensure their development is on track, they're getting the right nutrition and to ensure they are up-to-date on their vaccines. But how often are well visits allowed for children? Are you using the correct ICD-10 code for newborns? Below you will find the pediatric preventative medicine CPT codes along with corresponding ICD-10 codes that could be billed with it along with the schedule of when children should be seen for preventative visits.
The below table shows CPT codes for new patients, meaning the patient has not been seen by any health care professional in the same group, of the same specialty, in the last 3 years (to the day).
CPT Codes (New Patients) ICD-10 codes
99381 - Infant, younger than 1 year Z00.110 - Health exam for newborn under 8 days old
Z00.111 - Health exam for newborn 8-28 days old
Z00.121 - Health exam for child over 28 days old through 17 years old with abnormal findings
Z00.129 - Health exam for child over 28 days old through 17 years old without abnormal findings
99382 - Child age 1-4 years Z00.121 - Health exam for child over 28 days old through 17 years old 99383 Child age 5-11 years with abnormal findings
Z00.129 - Health exam for child over 28 99384 - Child age 12-17 years days old through 17 years old without abnormal findings
99385 - Adult age 18-39 Z00.00 - Health exam for adult without abnormal findings
Z00.01 - Health exam for adult with
abnormal findings
This table shows CPT codes for established patients.
CPT Codes (Established Patients) ICD-10 codes
99391 - Infant, younger than 1 year Z00.110 - Health exam for newborn under 8 days old
Z00.111 - Health exam for newborn 8-28 days old
Z00.121 - Health exam for child over 28 days old through 17 years old with abnormal findings
Z00.129 - Health exam for child over 28 days old through 17 years old without abnormal findings
99392 - Child age 1-4 years Z00.121 - Health exam for child over 28 days old through 17 years old 99393 Child age 5-11 years with abnormal findings
Z00.129 - Health exam for child over 28 99394 - Child age 12-17 years days old through 17 years old without abnormal findings
99395 - Adult age 18-39 Z00.00 - Health exam for adult without abnormal findings
Z00.01 - Health exam for adult with
abnormal findings
Now if an abnormality, illness or pre-exisiting condition is addressed during the preventative visit, which requires additional work-up and meets the requirements of an evaluation and management (E/M) service, then the appropriate outpatient service code (99201 - 99215) should be billed separately. Modifier 25 should be billed on the outpatient service code to indicated it was a significant, separately identifiable E/M service provided on the same day as the preventative visit.
So, how often are children supposed to have preventative visits? Below is the American Academy of Pediatrics (AAP) recommended schedule for pediatric well visits:
Newborn
3-5 days old
1 month old
2 months old
4 months old
6 months old
9 months old
12 months old
15 months old
18 months old
2 years (24 months) old
2 1/2 years (30 months) old
Once they reach 3 years old they should have a preventative visit once per year (at age 3, 4, 5, etc).
**This post only covers the preventative medicine service (office visit) and does not address any other procedures that could be billed separately.
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References: AAP's Coding for Pediatric Preventative Care, 2018
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