Welcome to our Coding Page!  The Practice Advisory committee is compiling codes which have posed issues over the last few months.  The Alphabetical Index below will bring you to the code, and the codes are in numerical order so that you may scroll down to them to search by code.

Below this is a Summary of the ICD-9-CM codes that are relevant for pediatricians, alphabetically listed.  It includes about 70% of the codes on the AAP ICD-9-CM flip-chart.  The following ICD-9 codes should be used as of October 1, 2009. Also, do not use the codes that have been deleted. As always, the problem will be those companies that will REJECT any claims that use the deleted codes and/or do not use the more specific codes. The converse, unfortunately, is also true – there will be companies that do not implement the updates for several months. Have staff be aware of this when a claim is not paid, or rejected without a clear explanation as to why.  There are many new E-codes – but they are never for the primary diagnosis.  New and deleted CPT codes will be available for 1/1/2010.

Alphabetical Index of Topics

After Hours      

College Exam            


Prolonged Service codes


Fussy Infant (Baby)


Excessive Crying, Infant Hib  Strep culture, overnight

Exposure, Anthrax

Influenza, preservative
free, 6-35 mo.

   3 cc           1 cc

Exposure, other Communicable

 Medical Necessity

Telephone Management

Flumist  Menactra  

Flumist Administration


Vaccine Administration  


  1. All types of the H1N1 – nasal, injectable, less than 3 or older, are all coded as 90663.
  2. They are provided free of charge, but the insurance companies need an amount to accept it into their systems, so use $0.01 (one cent).
  3. All of them are to be accompanied by the administration code 90470, which is for all ages.
  4. This admin code should be the FIRST vaccine – any others should be the ‘additional’ ones (i.e. seasonal Flumist – 90468 or 90474 for age).
  5. Only 2 vaccines should be reported on a HCFA page; this allows for concurrent administration of the seasonal Flu in the other arm (though it cannot be 2 nasal vaccines).
  6. NO CO-PAY should be taken if only the vaccine is administered.  However, there would be a co-pay if the patient is seen for another reason.
  7. All Flu vaccines use the same diagnosis code: V04.81


Summary of Pediatric ICD-9-CM Codes

789.00 Abd pain/Colic
706.1 Acne
079.0 Adenovirus
305.00 Alcohol abuse
287.0 Allergic purpura (HSP)
477.0 Allergic rhinitis
704.00 Alopecia
799.82 ALTE
626.0 Amenorrhea
041.84 Anaerobes
565.0 Anal fissure
285.9 Anemia
783.0 Anorexia
307.1 Anorexia Nervosa
300.00 Anxiety
786.03 Apnea
427.9 Arrhythmia
716.90 Arthritis
299.80 Asperger Syndrome
493.02 Asthma, acute exacerbation
493.00 Asthma, stable
493.01 Asthma, status
691.8 Atopic dermatitis/Excema
314.01 ADD w/Hyperactivity
314.00 ADD w/o Hyperactivity
388.45 Auditory processing disorder
299.00 Autism
279.49 Autoimmune disease – 279.49
771.83 Bacteremia, Newborn
607.1 Balanitis
V40.3 Behavioral problems
373.00 Blepharitis
368.8 Blurred vision
680.9 Boil
427.89 Bradycardia
779.81 Bradycardia, newborn
611.72 Breast lump/mass
466.11 Bronchiolitis, RSV
485 Bronchopneumonia
307.51 Bulimia
949.1 Burn,1st degree
949.2 Burn, 2nd degree
986 CO inhalation:
E868.8 Accidental
709.09 Cafe au lait spots
112.0 Candida, Oral (Thrush)
771.7 Candida, Newborn, Thrush
112.3 Candida, Skin
V02.59 Carrier, Meningococcus, Other Bacterial Disease
V02.52 Carrier, Strep, not Group B
078.3 Cat-scratch Disease
682.9 Cellulitis
767.1 Cephalohematoma, newborn
380.4 Cerumen, impacted
373.2 Chalazion
786.50 Chest pain
052.9 Chickenpox w/o Complications
780.71 Chronic Fatigue Syndrome
789.7 Colic
558.3 Colitis, allergic
850.5 Concussion w/LOC
850.0 Concussion w/o LOC
312.0x Conduct disorder, aggressive (bullying, stealing, defiance, lying)
312.1x Conduct disorder, unaggressive (tantrums, truancy)
5th digit:
*  0  unspecified
*  1  mild
*  2  moderate
*  3  severe
312.81 Conduct disorder, childhood onset
312.82 Conduct disorder, adolescent onset
312.89 Conduct disorder, other
312.9 Conduct disorder, unspecified (juvenile delinquency)
255.2 Congenital adrenal hyperplasia
744.3 Congenital ear anomaly, ear
372.0 Conjunctivitis,acute
372.05 Conjunctivitis allergic
771.6 Conjuntivitis/Dacryocystitis, newborn
372.03 Conjuntivitis, Purulent
077.99 Conjunctivitis, Viral
564.09 Constipation
924.9 Contusion
918.1 Corneal abrasion
733.6 Costochondritis
786.2 Cough
079.2 Coxsackievirus
464.4 Croup
277.09 Cystic Fibrosis w/ other sx
595.0 Cystitis
690.18 Dandruff
276.5 Dehydration
783.42 Delay in developmental milestones
733.91 Delayed bone age
259.0 Delayed puberty
521.00 Dental caries
692.9 Dermatitis, contact
110.9 Dermatophytosis, Ringworm
311 Depression
250.01 Diabetes Mellitus, Type 1
691.0 Diaper rash
787.91 Diarrhea
009.2 Diarrhea, Infectious
832.00 Dislocation, elbow/Nursemaid's
784.51 Dysarthria (DELETE: 784.5)
625.3 Dysmenorrhea
787.2 Dysphagia
041.4 E. coli
008.00 E. Coli Enteritis, unspecified
782.3 Edema
276.9 Electrolyte imbalance
049.9 Encephalitis, Viral
323.9 Encephalitis, unspecified
307.7 Encopresis
307.6 Enuresis
784.7 Epistaxis
381.81 Eustachian tube dysfunction
778.8 Erythema Toxicum newborn
530.81 Esophageal reflux
378.00 Esotropia
378.10 Exotropia
779.34 Failure to thrive
783.3 Feeding problem
779.31 Feeding problem, newborn (DELETE: 779.3)
778.4 Fever, Newborn
780.6 Fever of Unknown origin
057.0 Fifth Disease
704.8 Folliculitis
005.9 Food Poisoning
930.1 Foreign body, conjunctiva
931 F.B. ear
933.1 F.B. larynx
932 F.B. nose
934.9 F.B. respiratory
919.7 F.B. skin
939.2 F.B. vagina
605 Foreskin adhesions
824.8 Fx ankle
810.00 Fx, clavicle
767.2 Fx clavicle, newborn
816.00 Fx finger
813.80 Fx forearm
813.45 Fx radius

Torus (Buckle) fracture 

813.47 Fracture, Torus (Buckle) fracture + radius
826.0 Fx toe
814.00 Fx wrist
271.0 G6PD Deficiency
009.0 Gastroenteritis
558.9 Gastroenteritis, acute
009.0 Gastroenteritis, infectious
530.81 Gastroesophageal reflux
V26.3 Genetic counseling/Testing
529.1 Geographic tongue
240.0 Goiter
041.85 Gram-negative aerobes
686.1 Granuloma, umbilicus
611.1 Gynecomastia
768.70 HIE 
V08 HIV infection, no Sx
795.71 HIV Test, nonspecific results
041.5 H.influenzae
784.9 Halitosis
074.3 Hand, Foot, and Mouth Disease
784.0 Headache
307.81 Headaches-tension
389.00 Hearing loss
389.05 Hearing loss, Conductive, unilateral 
389.06 Hearing loss, Conductive, bilateral 
389.20 Hearing loss, Mixed
389.21 Hearing loss, Mixed, unilateral
389.22 Hearing loss, Mixed, bilateral
389.13 Hearing loss, Neurological
389.17 Hearing loss, Sensory
705.1 Heat rash
041.86 Helicobacter pylori
228.01 Hemangioma, skin
578.0 Hematemesis
599.7 Hematuria
282.7 Hemoglobinopathy
786.3 Hemoptysis
070.9 Hepatitis, unspecified
571.49 Hepatitis, chronic nonviral
573.1 Hepatitis w/ Inf Mono [w/075]
789.1 Hepatomegaly
553.1 Hernia, umbilical
074.0 Herpangina
054.9 Herpes Simplex
053.9 Herpes Zoster/Shingles
054.2 Herpetic Gingivostomatitis
704.1 Hirsutism
784.42 Hoarseness
373.11 Hordeolum (Stye)
272.0 Hypercholesterolemia
780.8 Hyperhidrosis/Excessive sweating
272.4 Hyperlipoproteinemia
401.9 Hypertension
474.11 Hypertrophy of tonsils
474.10 Hypertrophy of tonsils and adenoids
300.7 Hypochondriasis
458.9 Hypotension
279.3 Immunodeficiency, unspecified
684 Impetigo
799.23 Impulsiveness   
075 Infectious Mononucleosis
487.1 Influenza
488.0 Influenza due to Avian Influenza virus
488.1 Influenza due to novel H1N1 virus
703.0 Ingrown nail
919.5 Insect bite
799.22 Irritability  
564.1 Irritable bowel syndrome
774.39 Jaundice, newborn, breast-milk
774.6 Jaundice, newborm, physiologic
446.1 Kawasaki Ds/MCLS
623.2 Labial adhesion
386.30 Labyrinthitis
872.00 Laceration, ear
870.1 Laceration,eyelid
873.43 Laceration,lip
873.60 Laceration, mouth
873.20 Laceration, nose
873.74 Laceration,tongue
271.3 Lactase deficiency
315.31 Language developmental disorder
464.00 Laryngitis
748.3 Laryngomalacia, Tracheomalacia
464.20 Laryngotracheitis
790.99 Lead test/positive
315.2 Learning disorder
719.70 Limp
289.3 Lymphadenitis
780.79 Malaise and fatique
263.9 Malnutrition, unspecified
578.1 Melena
047.9 Meningitis,Viral
320.9 Meningitis, bacterial unspecified
320.82 Meningitis, Gram-negative
754.53 Metatarsus adductus
346.00 Migraine
579.8 Milk/formula intolerance
625.2 Mittelschmerz
078.0 Molluscum Contagiosum
785.2 Murmur, functional
041.81 Mycoplasma
703.8 Nail abnormalities/Onycholysis
471.0 Nasal polyps
470 Nasal septal deviation
787.02 Nausea
799.21 Nervousness  
288.0 Neutropenia
216.9 Nevus
832.2 Nursemaid's elbow 
379.50 Nystagmus
259.9 Obesity, endogenous
278.01 Obesity, morbid
278.00 Obesity, unspecified
V71.82 Obs for susp. Antrax exp
V71.83 Obs for susp Biologic agent exp
V71.89 Obs for susp-meningitis/septicemia
V29.0 Obs for susp inf, newborn
V71.2 Obs for susp TB
348.89 Ondine’s Curse
376.01 Orbital cellulitis
732.4 Osgood-Schlatter
388.70 Otalgia
380.10 Otitis externa
382.00 Otitis media, acute
382.01 Otitis media, acute, w/ rupture
382.3 Otitis media, chronic
381.10 Otitis media, serous
388.60 Otorrhea
785.1 Palpitations
300.01 Panic attack
681.02 Paronychia, finger
681.11 Paronychia, toe
132.1 Pediculosis/Lice, Body
132.0 Pediculosis, Head
754.82 Pectus carinatum
754.81 Pectus excavatum
384.20 Perforated eardrum
373.13 Periorbital cellulitis
475 Peritonsillar abscess
782.7 Petechiae
462 Pharyngitis
127.4 Pinworm
696.3 Pityriasis Rosea
041.2 Pneumococcus
788.42 Polyuria
521.8 Poor dentition
259.1 Precocious puberty
791.0 Proteinuria
593.6 Proteinuria, postural
041.7 Pseudomonas
374.30 Ptosis
312.33 Pyromania
782.1 Rash
493.90 Reactive Airway Disease
493.92 Reactive Airway Disease, acute
518.81 Respiratory failure, acute
752.52 Retractile testis
390 Rheumatic Fever
472.0 Rhinitis, chronic
079.3 Rhinovirus
058.10 Roseola infection, unspecified
058.11 Roseola due to Herpes 6
058.12 Roseola due to Herpes 7
008.61 Rotavirus Enteritis
133.0 Scabies
034.1 Scarlet Fever/Scarlatina
737.30 Scoliosis
608.89 Scrotal/testicular mass
706.3 Seborrhea
771.81 Sepsis, newborn
038.9 Septicemia, unspecified
785.59 Shock, septic
783.43 Short stature
786.05 Shortness of breath
461.9 Sinusitis, acute
473.9 Sinusitis, chronic
780.50 Sleep disturbance
782.2 Skin mass/lump/nodule
701.9 Skin tag
780.57 Sleep apnea
315.34 Speech and language delay due to hearing loss
784.59 Speech disturbance, other
845.00 Sprain/strain, ankle
842.10 Sprain/strain hand, finger
847.0 Sprain/strain neck
842.00 Sprain/strain wrist
041.11 Staphylococcus aureus
378.9 Strabismus
041.01 Streptococcus, Group A
034.0 Strep Throat
786.1 Stridor
528.2 Stomatitis
438.14 Stuttering 
692.71 Sunburn
757.6 Supernumerary nipple
380.12 Swimmer's ear
780.2 Syncope/fainting
795.5 TB Test positive
524.60 TMJ
785.0 Tachycardia
779.82 Tachycardia, newborn
786.06 Tachypnea
520.7 Teething
312.10 Temper tantrums
608.9 Testicular pain
307.20 Tic disorder
110.0 Tinea capitis (Scalp)
110.5 Tinea corporis (Body)
110.4 Tinea Pedis (Feet)
750.0 Tongue tie
463 Tonsillitis, acute
474.00 Tonsillitis, chronic
723.5 Torticollis/Wry neck
307.23 Tourette Syndrome
783.22 Underweight
598.80 Urethritis, non-STD
465.9 URI
788.41 Urinary frequency
708.9 Urticaria, hives
599.0 UTI
771.82 UTI, newborn
623.5 Vaginal discharge
989.5 Venomous bite (bee,jellyfish,snake,spider,tic)
057.9 Viral Exanthem
079.99 Viral Infection, unspecified
079.89 Virus, Other Specified
368.9 Visual disturbance
369.9 Visual impairment
709.01 Vitiligo
787.04 Vomiting  
536.2 Vomiting, persistent
779.32 Vomiting, other
779.32 Vomiting, bilious
078.19 Warts, Plantar
078.10 Warts, Unspecified
783.1 Weight gain
783.21 Weight loss
786.07 Wheezing


V15.83 Lapsed Immunization schedule
V18.0 Family history of diabetes
V20.31 Birth -7 day/o 
V20.32 8 day/o to 28 day/o 
V20.32 Newborn Weight check
V30.00 Liveborn, single
V30.01 Liveborn, single, cesarean
V31.00 Liveborn, twins
V31.01 Liveborn, twins, cesarean
V64.00 Vaccination not carried out, unspecified reason
V64.01 Vaccination not carried out because of acute illness
V64.02 Vaccination not carried out because of chronic illness or condition
V64.03 Vaccination not carried out because of immune compromised state
V64.04 Vaccination not carried out because of allergy to vaccine or component
V64.05 Vaccination not carried out because of caregiver refusal
V64.06 Vaccination not carried out because of patient refusal
V64.07 Vaccination not carried out for religious reasons
V64.08 Vaccination not carried out because patient had disease being vaccinated against

Vaccination not carried out for other reason

V65.11 Pre-birth visit expectant parents
V71.4 Observation after accident (incl. auto)
V71.3 Obs after accident, work or school
V71.6 Obs after assault
V29.8 Obs for other susp cond, newborn
V71.89 Obs for suspected condition [CF, DM, FB, Mening,suicide]
V71.2 Obs for susp TB
V70.3 Administrative exam for: adoption, camp, sports, school
V72.63 Pre-op labs 
V72.7 Allergy testing
V65.3 Diet management for specific conditions
V70.0 Exam, not child
V20.2 Infant/child health care
V72.84 Preoperative exam

NEED AT TIME OF VISIT [supplemental code]

V07.1 Allergy desensitization
V07.2 Prophylactic immunotherapy
V06.1 Vaccination-DaPT/DPT
V05.3 Vacc. Hepatitis
V03.81 Vacc. Hib
V04.8 Vacc. Influenze
V06.4 Vacc. MMR
V05.9 Vacc. other single disease
V03.89 Vacc. other specified bacteria
V03.82 Vacc. pneumococcus
V06.5 Vacc. Td/DT
V05.4 Vacc. Varicella

Pediatric immunization administration codes

   Reportable under the following circumstances:

1)      When the patient is under 8 years of age 


2)      When the physician performs the vaccine-related counseling. 

     If both of these conditions are not met (eg, a 4-year old who receives vaccines where the nurse does the counseling), physicians will be instructed to report the appropriate existing immunization administration code(s) (CPT 90471-90474).

The codes are:

90465 Immunization administration under 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; first injection (single or combination vaccine/toxoid), per day

(90465 should not be reported in conjunction with 90467)

90466 each additional injection (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure)

(Use 90466 in conjunction with 90465 or 90467)

90467 Immunization administration under age 8 years (includes intranasal or oral routes of administration) when the physician counsels the patient/family; first administration (single or combination vaccine/toxoid), per day

(90467 should not be reported in conjunction with 90465)

90468 each additional administration (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure)

(Use 90468 in conjunction with 90465 or 90467)

These codes (90465-90468) are reported only when the physician provides face-to-face counseling of the patient and family during the administration of a vaccine.  For immunization administration of any vaccine that is not accompanied by face-to-face physician counseling to the patient/family, report codes 90471-90474.

Telephone CPT Codes
(A direct link to the AAP Payment for Telephone Care toolkit can be found at

The AAP is pleased to announce that several new codes for non–face-to-face services (including telephone care and on-line medical services are now published in the 2008 Current Procedure Terminology (CPT®) manual.  The good news will continue later this month when, the Centers for Medicare and Medicaid Services (CMS), publishes relative values units (RVUs) in the November 27, 2007 Federal Register.  


The advent of new codes with relative values is the result of nearly 3 years of persistent advocacy by the AAP Section on Telephone Care (SOTC) and the Committee on Coding and Nomenclature (COCN) in partnership with other professional societies. While these developments represent an enormous step towards the goal of compensation for physician services by telephone, the approval of the codes and the assignment of RVUs does not ensure payment.


New CPT® Codes

These codes, include 3 time based codes for telephone care (99441, 99442, 99443) and 1 code for e-mail visits (99444).  They will be available for reporting starting on January 1, 2008.  


These major changes set the stage for physicians to secure payment for non-face-to-face services.  But it will not be effortless.  Practices will need to re-tool to implement these new codes and alert patients to the new billing policies. AAP chapters will need to educate payers through pediatric councils on the cost-effectiveness of non-face-to-face services. Pediatricians will need to bolster their negotiation and payer contracting skills.   The Academy will provide resources to help along the way (see coming resources).


The time-based telephone codes replace the existing telephone care codes (99371-99373) in the case management section of the CPT manual and are to be used to report a telephone E/M service provided by a physician to an established patient, parent or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours. 


Relative Values Assigned

After a national survey process in which many of you participated, the AMA/Specialty Society Relative Value Scale Update Committee (RUC) assigned RVUs to the non-face-to-face codes.  Although the RVUs were not quite as high as had been anticipated, the assignment of RVUs to the telephone codes was a critical step towards ultimately securing payment for telephone care.   In November, CMS published the codes and their RVUs in the Federal Register, although Medicare has classified them as “non-covered services.” The fact that these codes are not covered by the Medicare program is unfortunate, but not terribly problematic for pediatrics.  Very few pediatric services are covered by Medicare, and in the past pediatricians have been successful getting paid for codes similarly classified, such as the preventive medicine service codes.  The published RVUs represent an important benchmark as a starting point for negotiations with payers.


Unbundled Telephone Care

In the past, payers were correct in claiming that all telephone calls from one E/M visit until the next for a given patient were included in the post-service descriptor.  But this is no longer true. E/M codes’ current post-service descriptors state: that telephone care related to the specific visit only is considered as part of the “post service.”  Specifically, post services care is to include “necessary care coordination, telephonic or electronic communication assistance, and other necessary management related to this office visit.”

The key words, “related to this office visit” mean that telephone calls or e-mails for a clinical problem not related to the previous E/M service represent a new separately reportable medical encounter.   The non-face-to-face codes further specify that the telephone call or e-mail visit do not
originate from a related assessment or management services provided within the previous 7 days and nor leading to an assessment or management services in the next 24 hours or soonest available appointment.   Practices will need to build in some screening questions and data searches to verify that the non-face-to face encounter is a separately reportable service before generating a bill. 

E-Mail Visits

The other non-face-to-face CPT code may be used to report an on-line medical evaluation (99444), provided by a physician to an established patient, guardian or health care provider as long as it does not address a problem originating from an E/M service provided within the previous 7 days.  Although an RVU was proposed, the assigned value for 2008 is 0.  The Academy hopes to try for a reasonable value in the future. Meanwhile, physicians providing this service should report with the code, which replaces the now-sunset Category III CPT code for this service (0074T). Some insurers have already begun paying for e-mail visits.


United Health Care Developmental Screening

     In response to reported denials by UHC for developmental screening, clarification was obtained from Richard Justman, MD, UHC National Medical Director.  As part of the standard certificate of coverage, UHC Reimbursement policy is to pay separately for developmental screening (CPT code 96110).  The UHC Reimbursement policy can be accessed here.

    UHC acknowledged that due to a systems error, denials were processed incorrectly for certain services.  UHC is working to adjust claims that were incorrectly denied involving CPT code 96110 and there is no need for the physician to resubmit the claim.

    Below is the clarification provided by UHC:

Good morning,

    Thank you for bringing this to my attention.

    No, our policy has not changed.  However, we have identified a system error that has been incorrectly including certain cognitive services in other E/M codes.  We have corrected this error going forward.

    We will also adjust claims that have been incorrectly paid without physician need to seek individual claim adjustments.  I apologize for this error. Please let me know if you have questions.


Louis A. Terranova, MHA
Senior Health Policy Analyst
Private Payer Advocacy
Department of Practice
American Academy of Pediatrics
141 Northwest Point Blvd.
Elk Grove Village, IL 60007
800/433-9016 ext. 7633
Fax: 847/228/9651