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Forum: Pediatric Coding - Recent Topics en Sun, 12 Feb 2012 12:40:14 +0000 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-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/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/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-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-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/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/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> http://www.supercoder.com/forum/topic/code-for-racemic-epi#post-10030 Tue, 03 Jan 2012 15:42:19 +0000 Lawrenceville Pediatrics 10030@http://www.supercoder.com/forum/ <p>Can you please tell me which code to bill Racemic EPI under we<br /> billed J7699 and UHC denied the claim stating invalid CPT. </p> http://www.supercoder.com/forum/topic/newborn-charges-for-pediatrician-billing#post-9955 Thu, 29 Dec 2011 17:08:29 +0000 Ray Poquiz 9955@http://www.supercoder.com/forum/ <p>We have been billing hospital newborn charges with two modifiers when two procedures are done on the same day. For Example: 54150 (Circumcision) mod 59 and 99462 (Subsequent Hosp visit) mod 76. Is this correct or should we only be using one modifier when billing two procedures on the same day for our newborn charges? we also use the 76 modifier if it's the circumcision and the discharge billed on the same day. we always use the 59 modifier on the circumcision and the 76 modifier on the other procedure. please e-mail me at <a href="mailto:lvillarreal@totsandtykes.com">lvillarreal@totsandtykes.com</a> Thank you. </p> <p>Lucy M. Villarreal<br /> Tots and Tykes Pediatrics<br /> 817-652-3395 Ext: 23246 </p> http://www.supercoder.com/forum/topic/imm-reaction#post-9792 Wed, 21 Dec 2011 16:55:25 +0000 Lori Mongillo 9792@http://www.supercoder.com/forum/ <p>patient had a local reaction to a immuzation what diagnosis should we use?? </p> http://www.supercoder.com/forum/topic/gh-stim-testing#post-9827 Thu, 22 Dec 2011 13:37:12 +0000 Carolyn Carroll 9827@http://www.supercoder.com/forum/ <p>I am trying to find out the correct way to bill for GH stim testing. Can you tell me the correct codes to use? </p> http://www.supercoder.com/forum/topic/insurance-denied-cpt-87086-with-diagnosis-code-3076-pase-advise-alt-code#post-9795 Wed, 21 Dec 2011 17:56:40 +0000 Keith Campanelli 9795@http://www.supercoder.com/forum/ <p>'87086' '307.6' </p> http://www.supercoder.com/forum/topic/family-history#post-9692 Mon, 19 Dec 2011 18:24:25 +0000 Try Super 9692@http://www.supercoder.com/forum/ <p>I wanted to know if physicians can use (none) in family history? To me they cannot, they should state (none, as it does not relate to present illness/injury). Please advise, </p> http://www.supercoder.com/forum/topic/well-child-visit-bundling-with-previous-surgical-code#post-9747 Tue, 20 Dec 2011 20:11:04 +0000 Trina Stevens 9747@http://www.supercoder.com/forum/ <p>We saw a child for "incision and drainage", the patient returned 10 days later for a well-child exam, the insurance company is refusing to pay for the well-child exam, stating its "bundled" with the previous visit. We have tried using modifer 79, they denied this stating inappropriate modifer. Is there another modifer we should be using? Any help would be appreciated. </p> http://www.supercoder.com/forum/topic/adhd-consultation-without-patient#post-9693 Mon, 19 Dec 2011 18:42:46 +0000 Shaila Patel 9693@http://www.supercoder.com/forum/ <p>An ADHD patient's parents came for a consultation that the parents wanted without the child present. The doctor coded the visit as a 99214 based on time, but my understanding is that you cannot use an E/M code without a patient present. I showed him the CPT book where it says "The first 3 of these components (history, examination and medical decision making) are considered the key components in slecting a level of E/M services." Without the physical exam there can be no E/M service provided, correct?</p> <p>What then can we use? 96150-96155 and 99401-99429 are all face-to-face codes. 99354-99357 (face-to-face prolonged services) involves patient contact, and 99358-99359 refers to indirect contact *after* there was a face-to-face encounter. Medication management, 99605-99607, refers to services done by a pharmacist.</p> <p>The closest thing I could find was 90846 (family psychotherapy without the patient present)...would that be correct coming from a pediatrician for an ADHD consultation? </p> http://www.supercoder.com/forum/topic/tb-skin-test-reading#post-9645 Fri, 16 Dec 2011 13:19:32 +0000 Renee Krick 9645@http://www.supercoder.com/forum/ <p>A patient was hear for their yearly well child checkup. At this time a routine TB skin test was performed '86580-Tine Test'. Can we charge an office visit level 99211 code for when the patient returns two days later for the reading of the skin test? </p> http://www.supercoder.com/forum/topic/j0560#post-2748 Thu, 13 Jan 2011 19:45:34 +0000 Super Coder 2748@http://www.supercoder.com/forum/ <p>Hello all,</p> <p>Does anyone know if the J0560 600,000 is deleted and it states we are to use the J0561 100,000 how do I bill if 600,000 units are administered. Do I change quanity?</p> <p>Thanks,<br /> Patricia </p> http://www.supercoder.com/forum/topic/pre-op-vs-modifier-57#post-9296 Mon, 05 Dec 2011 16:10:22 +0000 Shaila Patel 9296@http://www.supercoder.com/forum/ <p>A patient came for warts, diaper rash and frequent falling as the chief complaint. Our doctor decided to do wart removal (17110), treat the diaper rash and refer out for the frequent falling. He discovered we were out of what we needed to treat the warts, and brought the child back in the next day. The next day, the product came in our order, the child was treated, and we billed the 17110 for that date.</p> <p>The insurance is denying the 1st day's E/M code because they are calling it pre-op for the 17110 that was done the next day. We've never had to deal with this before and are unfamiliar on how to appeal. Would we use modifier 57 for the 1st day as a "decision for surgery" (no 56 for pre-op) or do we appeal some other way? Is there something else we need to do since there were others issues treated as well?</p> <p>Thanks, Shaila </p> http://www.supercoder.com/forum/topic/ndc-for-flu-vaccines-1#post-8990 Tue, 22 Nov 2011 15:36:58 +0000 Lawrenceville Pediatrics 8990@http://www.supercoder.com/forum/ <p>Can you please tell me where to find the current NDC # for<br /> vaccines.I am printing the list off fda.org and now Tricare<br /> is stating that the list for 2011 termed on 6-7-2011.<br /> the NDC # for 90658 shows as 49281 0386 15 but per Tricare<br /> this number is incorrect. </p> http://www.supercoder.com/forum/topic/just-testing-the-system#post-8960 Mon, 21 Nov 2011 17:57:47 +0000 Lawrenceville Pediatrics 8960@http://www.supercoder.com/forum/ <p>just testing the system </p> http://www.supercoder.com/forum/topic/prevnar-13#post-8801 Wed, 16 Nov 2011 17:39:29 +0000 Arch Maharaja 8801@http://www.supercoder.com/forum/ <p>What is the proper way to bill for Prevnar-13? </p> http://www.supercoder.com/forum/topic/question-on-cpt-90473-90474#post-8687 Mon, 14 Nov 2011 18:54:13 +0000 Lawrenceville Pediatrics 8687@http://www.supercoder.com/forum/ <p>Please verify for me in what instances we can use 90473 with regards to 90460, 90461, 90471 or 90472?</p> <p>Example: We billed 90460 &amp; 90461 with 90474 and UHC denied the 90474 reimbursement stating that we should billed the 90473.</p> <p>And, they are also saying if we do not have 90471 or 90473 on the claim we cannot bill 90474, even when using 90460 or 90461 with an oral or nasal vaccine administration?</p> <p>Could you please advise as to the correct way we should be billing<br /> this admin fee. </p> http://www.supercoder.com/forum/topic/well-sick-visit-on-the-same-day#post-8683 Mon, 14 Nov 2011 18:12:48 +0000 Lawrenceville Pediatrics 8683@http://www.supercoder.com/forum/ <p>A newborn is brought in for the 4 day check up we billed<br /> cpt 99381 but while doing the newborn check up a problem<br /> is found would we bill cpt 99212-25 or would another cpt<br /> be a better choice. </p> http://www.supercoder.com/forum/topic/question-on-admin-fees-90473-90474#post-8515 Thu, 10 Nov 2011 14:03:45 +0000 Lawrenceville Pediatrics 8515@http://www.supercoder.com/forum/ <p>I just want to make sure the information we are beimg given<br /> is correct. When billing a flumist the correct admin fee is<br /> 90473.When giving a flumist and a rotavirus use 90473 on the<br /> first vaccine and 90474 on the second vaccine. </p> http://www.supercoder.com/forum/topic/ndc-for-flu-vaccines#post-8227 Mon, 31 Oct 2011 17:42:17 +0000 Lawrenceville Pediatrics 8227@http://www.supercoder.com/forum/ <p>New NDC # for 2011 flu vaccines . You may want to go online<br /> and print out the new list. </p> http://www.supercoder.com/forum/topic/newborn-discharge-denial#post-8152 Fri, 28 Oct 2011 01:01:19 +0000 Patricia davis 8152@http://www.supercoder.com/forum/ <p>Hi All, </p> <p>We received a denial for hospital discharge post op denial? The procedure was a digit removal the day before the discharge. Would you add the 55 modifier to the 99338?</p> <p>Thanks, Patricia </p>