343- EI Billing Coding Notice: Diagnosis Code V79.3

Following a routine review of the Medicaid rejections received on EI Billing claims, PCG found that some EI Billing Providers are billing claims with diagnosis code V79.3. This code is not a billable ICD-10 code for claims with a date of service on or after October 1, 2015.  While V79.3 was billable as an ICD-9 code with the description: “Screening for developmental handicaps in early childhood”, following the transition to ICD-10, the description for V79.3 is now: “Bus occupant (driver) (passenger) injured in unspecified non-traffic accident”.

There is a group of ICD-10 codes related to screenings that can be used prior to a diagnosis being made.

The ICD-9 code V79.3 converts approximately to ICD-10 code Z13.4 “Encounter for screening for certain developmental disorders in children”. Approximate synonyms listed for this code include:

• Developmental screening for autism in toddlers
• Developmental screening for autism in toddlers done
• Developmental screening for autism in toddlers done (situation)
• Developmental screening for physical therapy, occupational therapy and speech therapy needs
• Screening for developmental handicap
• Screening for developmental handicap done
• Screening for developmental handicap done (situation)
• Screening for developmental problems in early childhood
• Screening for developmental problems in early childhood done
• Screening for developmental problems in early childhood done (situation)
• Screening for physical therapy, occupational therapy and speech therapy needs for developmental delay

Translating from an ICD-9 code to an ICD-10 code may be done in a number of ways:

• The EIP provider may request the practitioner that originally conducted the evaluation or wrote the prescription, order, written recommendation, or referral containing the ICD-9 code to provide the ICD-10 code to be used on and after October 1, 2015
• The EIP provider may request the child’s primary health care provider to “translate” the “reason/need” wording or the ICD-9 to an appropriate ICD-10 code
• Consulting coding books and resources
• Consulting coding professionals with adequate experience
• Contacting physicians or other health professionals

If you have any questions, please contact the PCG Customer Service Call Center at (866) 315-3747.