PEDIATRIC PAYMENT 99460: Look for a 61 Percent Boost to Your Initial Newborn Care Services (February 2012) First Release
Plus: Office-based well child visits also get a raise.
You may not treat Medicare patients, but most pediatricians know that private carriers frequently base payment rates on the Medicare Physician Fee Schedule-and this year, you’ll be seeing significant pay raises to many of the most commonly-billed pediatric codes.
Background: The Centers for Medicare & Medicaid Services (CMS) updates its fee schedule on a quarterly basis. The fee schedule assigns different relative value units (RVUs) to every [...]
Medicaid: 96110: Use This Tool to Fight Medicaid Denials for Developmental Screening (January 2012)
Although CMS originally withheld RVUs for this code, you’ll now find an update.If your Medicaid provider is sending back your developmental screening claims and marking them “denied,” there’s a powerful new tool that can help you fight those zero-reimbursement situations.Issue Lies in Testing vs. Screening DifferenceAlthough most annual CPT® updates have the potential to help your practice substantially, others can threaten to bring your income to a halt. Unfortunately, that’s been the case for scores [...]
Plus: New edition of bundling edits targets 2012 CPT codes.You may just be digging in to your 2012 CPT book, but the Correct Coding Initiative (CCI) has already taken aim at some of the new codes by bundling them into existing codes effective Jan. 1.The CCI released version 18.0 at the end of 2012, revealing 15,530 new active pairs and 6,197 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank [...]
E/M Coding: 99058: ‘Walk-in’ Patients Alone Won’t Qualify You for This Emergency Code (January 2012)
Highlight the phrase “in addition to basic service.”Pediatricians don’t always see patients during scheduled office visits, which means you probably see walk-in patients almost every week. Although some practices immediately stamp a 99058 code on all walk-in claims, you should avoid adding this code to your visit unless you can prove that the patient’s visit is truly emergent.Office Emergency Points to 99058Think “emergency” and “interruption” when considering whether to include 99058 (Service[s] provided on an [...]
ICD-10: CMS Outlines New ICD-10 Codes for 2012 (January 2012)
Consider these changes that have already been instituted before the code set even takes effect.You may not be completely familiar with the ICD-10 code set yet, but it continues to grow anyway. CMS recently posted the 2012 ICD-10 code update, which not only shows which codes were added, deleted, and revised this year, but also offers information on the new diagnosis coding system, which will be mandatory for all providers as of Oct. 1, 2013.For [...]
You Be the Coder: Know the Ropes for Reporting Sick Evaluation During Well Visit (January 2012)
Question: When parents present with infants for regular health checkups at two, four, and six months, I spend a lot of time counseling and treating colic and GE reflux. Can I report 99212-25 with the ICD-9 code for colic (789.7) or gastroesophageal reflux (530.81) along with 99391 (linked to ICD-9 code v20.2 for a well baby visit)?Tennessee SubscriberAnswer: According to CPT, you can bill a sick visit (Office or other outpatient services codes 99212-99215) in [...]
Question: Two of our insurers follow the Medicare fee schedule in assigning fees, and we read your article about the projected 27 percent conversion factor cut with interest. Has this cut gone into effect?Alabama SubscriberAnswer: No, fortunately the cut has not gone into effect. Although the government appeared poised to take a big bite out of your next payments, you have another two months before you need to worry about losing pay. That’s because the [...]
Reader Question: Elucidate Recording of ‘None’ for Family History (January 2012)
Question: Our physician often records the word “none” under the “family history” section of his E/M notes for a privately-insured patient. To me, that isn’t comprehensive enough for me to count as being completed, but the physician disagrees. In my opinion, it would only count if the pediatrician recorded something more along the lines of “none that relate to the present illness/injury.” Can you advise? Oklahoma SubscriberAnswer: The answer comes down to the auditing rules [...]
Reader Question: ‘Prevnar-13’ Does Not Contain 13 Components (January 2012)
Question: What is the proper way to bill for Prevnar-13? Our coding/billing staff is confused about whether it includes thirteen individual components for billing for vaccine administration.Florida SubscriberAnswer: Prevnar-13 has only one component, (Pneumococcal), although it contains 13 antigens. Therefore, the most appropriate CPT code would be 90670 (Pneumococcal conjugate vaccine, 13 valent, for intramuscular use) for the vaccine, and 90460 (Immunization administration through 18 years of age via any route of administration, with counseling [...]
Reader Question: Consider These Diabetes Education Options (January 2012)
Question: A pediatrician and physician assistant are educating some parents on diabetes, exercise, and nutrition at our practice twice a month. The plan is to bring the patients in at 4:45 to workup the patient, and start the group session at 5 p.m. for about 45 minutes to an hour. Can practices report these services? Will carriers pay for them?Michigan Subscriber Answer: You have a few options depending on what insurers cover.Option 1: For the [...]
