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Forum: Pediatric Coding - Recent Posts en Sun, 12 Feb 2012 11:50:50 +0000 http://www.supercoder.com/forum/topic/billing-an-office-visit-with-a-peak-flow-and-nebulizer-treatment#post-11183 Sun, 05 Feb 2012 04:59:58 +0000 Sanjit Mishra 11183@http://www.supercoder.com/forum/ <p>You may give a try using 25 modifier with 99213, but no guarantee of reimbursement.<br /> But the Guidelines are as follows:<br /> Medicare and many commercial carriers won't pay for the pulse oximetry codes 94760 (noninvasive ear or pulse oximetry for oxygen saturation; single determination) or 94761 (multiple determinations [for example, during exercise]) when billed in conjunction with evaluation/management (E/M) or other services.<br /> *<br /> Although the CPT guidelines allow separate coding of diagnostic tests ordered/interpreted during a patient E/M encounter (subsection "Levels of E/M Services" in the E/M Services Guidelines), Medicare ruled in 1999 that pulse oximetry is no more difficult than taking a patient's temperature and should be reflected as such. As a result, it is included in any E/M code submitted.<br /> *<br /> Medicare gives codes 94760–94761 a payment status of "T," which means they're bundled into any procedure or visit performed on the same day. This fact means that you cannot bill the pulse oximetry codes when any other code is billed for that date of service.<br /> *<br /> When no other service is provided on that day, you can bill pulse oximetry alone, but you'll still need to make sure your documentation supports medical necessity. Medicare will allow payment for oximetry when accompanied by an appropriate ICD-9-CM code for a pulmonary disease, which is commonly associated with oxygen desaturation.<br /> *<br /> Medically necessary reasons for pulse oximetry:<br /> -----------------------------------------------<br /> 1. A patient exhibits signs or symptoms of acute respiratory dysfunction.<br /> *<br /> 2. A patient has chronic lung disease, severe cardiopulmonary disease, or neuromuscular disease involving the muscles of respiration, and oximetry is needed for at least one of the following reasons:<br /> *<br /> -Initial evaluation to determine the severity of respiratory impairment.<br /> -Evaluation of an acute change in condition.<br /> -Evaluation of exercise tolerance in a patient with respiratory disease.<br /> -Evaluation to establish medical necessity of oxygen therapeutic regimen.<br /> 3. A patient has sustained severe multiple trauma or complains of acute severe chest pain.<br /> *<br /> 4. A patient is under treatment with a medication with known pulmonary toxicity, and oximetry is medically necessary to monitor for potential adverse effects. </p> http://www.supercoder.com/forum/topic/billing-an-office-visit-with-a-peak-flow-and-nebulizer-treatment#post-11171 Fri, 03 Feb 2012 22:45:17 +0000 Ray Poquiz 11171@http://www.supercoder.com/forum/ <p>we billed an office visit of 99213 along with a peak flow 94760 and nebulizer treatment of 94640. our office visit was denied payment because it was bundled with the 94640. the peak flow (94760) was billed with a modifier 25 but we were told that the office visit should have also been billed with a modifier. we have never billed a modifier for the office visit when billed with the 94760 or the 94640 but should we be billing with one? and if so is it the modifier 25? </p> http://www.supercoder.com/forum/topic/discharge-cpt-code-for-newborn#post-11111 Thu, 02 Feb 2012 15:30:32 +0000 Sanjit Mishra 11111@http://www.supercoder.com/forum/ <p>99238 Hospital discharge day management; 30 minutes or less<br /> 99463: Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date </p> http://www.supercoder.com/forum/topic/icd-9-question-2#post-11058 Tue, 31 Jan 2012 19:43:25 +0000 Leesa Israel 11058@http://www.supercoder.com/forum/ <p>603.9 is the correct code for a testicular hydrocele. What is the denial saying exactly? Perhaps this is an error in the payer's system?<br /> *<br /> Best,<br /> Leesa<br /> *<br /> Leesa A. Israel, BA, CPC, CUC, CMBS<br /> Executive Editor, The Coding Institute<br /> Manager, TCI Consulting &amp; Revenue Cycle Solutions<br /> Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a><br /> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> </p> http://www.supercoder.com/forum/topic/icd-9-question-2#post-11053 Tue, 31 Jan 2012 18:53:55 +0000 Lawrenceville Pediatrics 11053@http://www.supercoder.com/forum/ <p>ICD-9 603.9 Hydrocele ( testes) is being denied by<br /> Blue Cross &amp; Blue Shield stating invalid ICD-9. Can<br /> you please give me the correct ICD-9 to use. </p> http://www.supercoder.com/forum/topic/discharge-cpt-code-for-newborn#post-11046 Tue, 31 Jan 2012 17:31:37 +0000 Sandra Proffitt 11046@http://www.supercoder.com/forum/ <p>We use '99460' for admitting a newborn and '99462' for subsequent visits. What CPT code should you use for discharge if it is NOT on the same day ? </p> http://www.supercoder.com/forum/topic/preventive-visit-code-for-pt-4-year-2-month-old#post-10805 Tue, 24 Jan 2012 20:44:48 +0000 Vijay Gawade 10805@http://www.supercoder.com/forum/ <p>This visit is for established patients making a well baby/well child care visits. </p> http://www.supercoder.com/forum/topic/preventive-visit-code-for-pt-4-year-2-month-old#post-10804 Tue, 24 Jan 2012 20:24:49 +0000 Vijay Gawade 10804@http://www.supercoder.com/forum/ <p>We have patient with age 4 year &amp; 2 month so which preventive Visit code would be appropriate 99392 or 99393? </p> http://www.supercoder.com/forum/topic/nicu-charges#post-10801 Tue, 24 Jan 2012 19:45:03 +0000 Shana Adams 10801@http://www.supercoder.com/forum/ <p>Thank you! </p> http://www.supercoder.com/forum/topic/nicu-charges#post-10797 Tue, 24 Jan 2012 18:49:56 +0000 Sanjit Mishra 10797@http://www.supercoder.com/forum/ <p>The concept is simple and clearcut. There should not be any confusion at all if the documentation is complete and clear.<br /> NICU/PICU services when directing the care of a neonate/infant in a NICU/PICU. These codes represent care beginning with the date of admission to the NICU/PICU.<br /> Ref: Page:B-19 of :<br /> <a href="http://hrsa.dshs.wa.gov/Download/Billing_Instructions/Physician-Related_Svcs/January_1_2011-April_1_2011/Section_B.pdf" rel="nofollow">http://hrsa.dshs.wa.gov/Download/Billing_Instructions/Physician-Related_Svcs/January_1_2011-April_1_2011/Section_B.pdf</a><br /> *<br /> Based on above premise, before admission into NICU, the services are to be considered as Newborn Care Services.<br /> So, here, NICU starts on DOS 12/16/2011, so E/M service for DOS 12/16/2011 to be coded as Initial Inpatient Neonatal Critical Care,per day, with cpt 99468. Subsequent NICU per day to be coded from the next day(from 12/17/2011) as 99469. </p> http://www.supercoder.com/forum/topic/nicu-charges#post-10767 Mon, 23 Jan 2012 22:30:36 +0000 Shana Adams 10767@http://www.supercoder.com/forum/ <p>Per CPT book, "Codes 99468 and 99469 are used to report services provided by a physician directing the inpatient care of a critically ill neonate or infant 28 days of age or younger. They represent care starting with the date of admission (99468) and subsequent days 99469 that the neonate remains in critical". I guess my confusion is in this case is the baby was born in hospital on 12/13/11, but not NICU. Baby did not transfer to NICU until 12/16/11, so do i code Initial Inpatient Neonatal Critical care, per day (28 days of age or younger): or subsequent days since since day 4 is what's in question. Sorry for all the questions, just want to code charges correctly. </p> http://www.supercoder.com/forum/topic/nicu-charges#post-10766 Mon, 23 Jan 2012 21:46:48 +0000 Shana Adams 10766@http://www.supercoder.com/forum/ <p>I agree with code but our billing/keying personal feels like it should be 99469 because the infant was already in hopstial, but not in NICU. Do you have any documentaion to support besides what is in book? </p> http://www.supercoder.com/forum/topic/nicu-charges#post-10755 Mon, 23 Jan 2012 20:05:15 +0000 Sanjit Mishra 10755@http://www.supercoder.com/forum/ <p>1st day NICU: 12/16/2011: Initial Inpatient Neonatal Critical care, per day (28 days of age or younger): Justified and correct. Please let me know the reason for confusion. </p> http://www.supercoder.com/forum/topic/office-visit#post-10742 Mon, 23 Jan 2012 17:27:26 +0000 Sanjit Mishra 10742@http://www.supercoder.com/forum/ <p>Paragraph B of Chapter 12, Section 30.6.7, clarifies “physician in a group practice” for office/outpatient E/M Visits provided on the same day for unrelated problems as follows:<br /> As for all other E/M services except where specifically noted, carriers MAY NOT pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician documents that the visits were for unrelated problems in the office or outpatient setting which could not be provided during the same encounter (e.g., office visit for blood pressure medication evaluation, followed five hours later by a visit for evaluation of leg pain following an accident).</p> <p>Ref:<br /> <a href="https://www.cms.gov/mlnmattersarticles/downloads/MM4032.pdf" rel="nofollow">https://www.cms.gov/mlnmattersarticles/downloads/MM4032.pdf</a><br /> NOTE<br /> ====<br /> Non-Medicare payers can make their own payment guidelines. It is always safe to be aware of payer specific guidelines on this and make your physician aware of this. </p> http://www.supercoder.com/forum/topic/nicu-charges#post-10729 Mon, 23 Jan 2012 14:32:39 +0000 Shana Adams 10729@http://www.supercoder.com/forum/ <p>A baby was born on 12/13/2011 in hosp. sent to NICU (Same hosp) 12/16/2011 for thrombocytopenia, sepsis E coli and meningitis bacterial. The physician coded 99468, 1st day NICU. Is this correct and if not what code should I use. </p> <p>Thanks,<br /> Shayna </p> http://www.supercoder.com/forum/topic/office-visit#post-10710 Fri, 20 Jan 2012 18:23:18 +0000 Vijay Gawade 10710@http://www.supercoder.com/forum/ <p>Hi Sanjit,<br /> Can we bill 2 office visit on same Day? i came with a query were i found CPT99214 billed twice in same day with different diagnosis and insurance paid one and other denied, could you please help me on this if we can use modifier or this would be provider's write off.</p> <p>Thanks &amp; Regards<br /> Vinayak<br /> wideangleoutsourcing </p> http://www.supercoder.com/forum/topic/cpt-90460-90461-for-blue-cross-healthy-families#post-10568 Tue, 17 Jan 2012 17:01:25 +0000 Try Super 10568@http://www.supercoder.com/forum/ <p>Thank you again for your reply,<br /> I have also spoken with one of the senior rep with BC of CA Healthy Families and even she told me the same way of billing which is showing in the link you send us. We are sending them a corrected claim and once i get any response i would surely let you know about it.</p> <p>Thank you once again Sanjit this was very helpful for us. </p> http://www.supercoder.com/forum/topic/cpt-90460-90461-for-blue-cross-healthy-families#post-10553 Tue, 17 Jan 2012 11:10:12 +0000 Sanjit Mishra 10553@http://www.supercoder.com/forum/ <p>Because of the high frequency of denials on this context, you may find some differences, but I think BCBS must be following as a broad guideline. Please try with a "Letter of Appeal", and let me know the result. </p> http://www.supercoder.com/forum/topic/cpt-90460-90461-for-blue-cross-healthy-families#post-10533 Mon, 16 Jan 2012 18:12:14 +0000 Try Super 10533@http://www.supercoder.com/forum/ <p>Thanks for your help</p> <p>The link you provided gives the guidelines for BCBS of North Carolina , is it applicable for blue cross of CA ( Healthy Families Plan)?</p> <p>Can you please clarify on this? It would be very helpful for us.. </p> http://www.supercoder.com/forum/topic/92587-oae-as-audio-screening-tool#post-10522 Mon, 16 Jan 2012 02:26:06 +0000 Sanjit Mishra 10522@http://www.supercoder.com/forum/ <p>Used specifically on children. Details in the given link:<br /> <a href="http://www.infanthearing.org/earlychildhood/docs/OAE_Hearing_Screening.pdf" rel="nofollow">http://www.infanthearing.org/earlychildhood/docs/OAE_Hearing_Screening.pdf</a> </p> http://www.supercoder.com/forum/topic/cpt-90460-90461-for-blue-cross-healthy-families#post-10515 Sun, 15 Jan 2012 14:30:48 +0000 Sanjit Mishra 10515@http://www.supercoder.com/forum/ <p>Please check the below link for BCBS guidelines and particularly the Example for the way multiple units of 90460 and 90461 is to be billed.<br /> <a href="http://www.bcbsnc.com/content/providers/important-news/aug19-2011.htm" rel="nofollow">http://www.bcbsnc.com/content/providers/important-news/aug19-2011.htm</a><br /> Revert back to me if you need further clarification. </p> http://www.supercoder.com/forum/topic/cpt-90460-90461-for-blue-cross-healthy-families#post-10493 Fri, 13 Jan 2012 21:38:25 +0000 Try Super 10493@http://www.supercoder.com/forum/ <p>Hi Sanjit Mishra</p> <p>We are getting denial for CPT 90460 &amp; 90461 if we bill this CPT multiple times on same day for Blue Cross Healthy Families, for other blue cross &amp; blue shield plan we are getting payments for 5 Immune Admin codes billed on same day, so is their any particular way to bill Immunization Code for Blue Cross Healty Families?<br /> i found online that we need to bill 90460 x no.of units instead of billing 1 unit per line item for Blue Cross Healthy families is this correct way of billing? because i am not getting any help from insurance rep as they say CPT 90460 &amp; 90461 are paid one unit per day but we are getting payments for some accounts for more than 2 Immunization Code but they are not ready to send claim back for reprocessing.</p> <p>Please Help </p> http://www.supercoder.com/forum/topic/92587-oae-as-audio-screening-tool#post-10475 Fri, 13 Jan 2012 15:59:54 +0000 Gustavo Valles 10475@http://www.supercoder.com/forum/ <p>We just recently purchased an OAE hearing machine and my understanding from how it was explained to us by the sales rep was that this machine is commonly use as a hearing screening tool. As a pediatric practice, could this machine be used on every physical, regardless of age, as a way to test the patient's hearing? </p> <p>Thanks for your response in advance. </p> http://www.supercoder.com/forum/topic/cpt-90460-90461-for-blue-cross-healthy-families#post-10403 Thu, 12 Jan 2012 16:44:12 +0000 Try Super 10403@http://www.supercoder.com/forum/ <p>Hi Sanjit Mishra</p> <p>We are getting denial for CPT 90460 &amp; 90461 if we bill this CPT multiple times on same day for Blue Cross Healthy Families, for other blue cross &amp; blue shield plan we are getting payments for 5 Immune Admin codes billed on same day, so is their any particular way to bill Immunization Code for Blue Cross Healty Families?<br /> i found online that we need to bill 90460 x no.of units instead of billing 1 unit per line item for Blue Cross Healthy families is this correct way of billing? because i am not getting any help from insurance rep as they say CPT 90460 &amp; 90461 are paid one unit per day but we are getting payments for some accounts for more than 2 Immunization Code but they are not ready to send claim back for reprocessing. </p> <p>Please Help<br /> Vinayak<br /> Wideangleoutsourcing.com </p> http://www.supercoder.com/forum/topic/colic-ge-reflux-with-well-baby-visit#post-10221 Sun, 08 Jan 2012 21:14:25 +0000 Sanjit Mishra 10221@http://www.supercoder.com/forum/ <p>There is no problem in billing this, the only criteria is, the E/M documentation for both if done separate and distinct on the same medical record, to justify billing for both. </p> http://www.supercoder.com/forum/topic/ekg-before-starting-adhd-medication#post-10214 Fri, 06 Jan 2012 22:19:15 +0000 Sanjit Mishra 10214@http://www.supercoder.com/forum/ <p>ADHD is a time-consuming assessment as you know. In the context of that, say, it takes one and a half hours to do the ADHD workup. In that case, you can bill Officie visit (99213). You also need to document time carefully so as to justify using 99354 for prolonged services provided.<br /> If at the same time you have provided interpreation of EKG only interpretation(cpt 93010)<br /> So, you can code:<br /> 99213-25<br /> 99354<br /> 9310 ........ 794.31</p> <p>ICD coding:<br /> Do not use the ICD-9 code for ADHD (314.00 or 314.01) for these evaluations. Learning problems (V40.0) or behavior problems (V40.3 or V40.9) are the most appropriate. However, these are V codes, and some insurance companies dont pay them. </p> http://www.supercoder.com/forum/topic/jaundice-with-new-born-visit#post-10211 Fri, 06 Jan 2012 21:20:08 +0000 Sanjit Mishra 10211@http://www.supercoder.com/forum/ <p>99212-25...............774.6<br /> 99381 -------------- V70.0 </p> http://www.supercoder.com/forum/topic/colic-ge-reflux-with-well-baby-visit#post-10201 Fri, 06 Jan 2012 18:41:53 +0000 Srinivasa Yerasi 10201@http://www.supercoder.com/forum/ <p>In infants coming for regular health checkup for 2mon, 4 mon, 6 mon visits, I spend a lot of time counselling and treating colic and GE reflux.</p> <p>Can I do '99212 mod 25' with ICD code (colic 789.7) or (GE Reflux 530.81) along with 99391 (with ICD v20.2 - well baby). </p> http://www.supercoder.com/forum/topic/ekg-before-starting-adhd-medication#post-10199 Fri, 06 Jan 2012 18:33:49 +0000 Srinivasa Yerasi 10199@http://www.supercoder.com/forum/ <p>I frequently see kids with ADHD and start ADHD medications. I do EKG as initial workup. My staff does the EKG adn I interprit it. What ICD code and Charges can I do for EKG? </p> http://www.supercoder.com/forum/topic/jaundice-with-new-born-visit#post-10192 Fri, 06 Jan 2012 17:03:46 +0000 Srinivasa Yerasi 10192@http://www.supercoder.com/forum/ <p>I see a new born first visit. We evaluate for Jaundice. Can we do '99381' and 99212 mod 25 with ICD 774.6 (Jaundice neonatal). </p> <p>Two situations can exist. One - I may do Total Bili, other situation - Just clinical exam to say jaundice is resolving.</p> <p>What situations I can use 99212 mod 25? </p>