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Pediatric Coding Alert

Learn 7 Must-Know Principles of Moderate Sedation Coding
CPT 2006 replaces 99141-99142 with provider, age and time-specific codes This winter you ... Read more
Identify These Characteristics to Differentiate Between 99143-99150
Clip and post your quick reference guide to moderate sedation codingYou can easily choose ... Read more
NCCI Update:
Simple Strategy Bypass Injection-E/M Insurer Bundle
Tell payers 'NCCI 11.3 supports 90788 as separately payable from E/M service' ... Read more
Fight Payer's Reverse Injection-OV Edit by Educating Rep
Stress patient can't receive shot without pediatrician evaluationOverturning one carrier's... Read more
Roll Same-Day OV Into Hospitalist Admission
Question: Pediatrician A treats a patient in the office in the morning. Pediatrician B, wh... Read more
Make Forms Completion a Self-Pay Service
Question: One of our patients who visits our office yearly is severely physically and ment... Read more
Submit 3 Codes for New Fluarix
Question: How should I code the new Fluarix TIV influenza vaccine for individuals less tha... Read more
You Be the Coder:
Practice Sequencing Preop Exams' Diagnoses
Question: When a pediatrician performs a preoperative exam for a patient who is scheduled ... Read more
Try 5 Winning Strategies to Gain Service Payment With Circ
54150 now contains 0 global days, and E/M code inclusion is sexually biasedYou can fight s... Read more
Tackle Circ-Triggered E/M-Service Denial in 3 Easy Steps
Lean on these sources for ammunition--if your coding passes musterWhen you're unsure wheth... Read more
Find Out Who Has to Perform What to Bill 69210 Correctly
You finally have a definitive answer to cerumen removal code's requirementsThe AMA ends th... Read more
Adopt Payer's Rapid Flu Test B Coding Instruction
Question: An insurance company recommended we code influenza test A+B as 87804-QW and 8780... Read more
Report Documented Group Critical Care Time
Question: When pediatricians in a group practice perform critical care individually on the... Read more
Usually Omit Modifier on Add-on Admin Codes
Question: What modifier should I use for multiple vaccination administration codes CPT 904... Read more
Opt for S Code Instead of H Code
Question: We give patients oral Dexamethasone instead of an injection. Only one payer reim... Read more
Check Your 832 5th Digit
Question: What is the correct diagnosis code for a nursemaid's elbow? We are using ICD9 83... Read more
You Be the Coder:
How to Code Counseling-Dominated 2nd Service
Question: May I use time to select a second E/M code even if the other service code isn't ... Read more
Pediatricians Welcome Great News of CPT 2006's Expanded CPO Services
Claim only solidly documented modifier 25 services Two new care plan services codes solve... Read more
3 Steps Nail Down the Correct Indirect Supervision Code
Tally telephone calls, lab review, care plan revision minutes If you think you perform ca... Read more
Use Setting, Source to Assign Future Confirmatory Consult
CPT Codes 2006 eliminates 99271-99275 with ambiguous language In 2006 when your pediatr... Read more
New Year Rings in Fewer Inpatient Consultation Choices
Submit follow-up consults as subsequent hospital care The year 2006 will streamline yo... Read more
Clip and Save:
Your Guide to Top-4 CPT Pediatric E/M Changes for 2006
  This chart shows you what codes to use instead of confirmatory/follow-up co... Read more
Reader Questions:
Charge Extra E/M Service for 2nd Direct Visit
Question: The August 2005 Pediatric Coding Alert suggests coding an additional E/M service... Read more
Reader Questions:
Guidelines' Omission Implies HPI Rule
Question: I have always believed that any staff can take two of the history elements, but ... Read more
Reader Questions:
AMA Eliminates Modifier Hyphen
Question: I noticed that the September Pediatric Coding Alert didn't include a hyphen befo... Read more
Reader Questions:
Proposed IA Code Values Fill RVU Scale Void
Question: What immunization administration (IA) code should I use for FluMist? Because thi... Read more
You Be the Coder:
2 Removals Are Similar -- and Different
Question: A pediatrician removed an extra digit from a newborn’s hand, and removed... Read more
Pharmacologic Management Doesn't Correctly Describe ADD Follow-up Visits
Better method: Bill rechecks with 99212-99215, not CPT 90862 When coding for AD... Read more
Payers May Adopt Medicare Observation Care Rules
Choose between 99217-99220 and 99234-99236 based on date, timeIf you let your observation ... Read more
Use This Chart to Select the Right Observation Code Every Time
Extended single-day observation admit, discharge should pay the same as 2-day ... Read more
4 Guidelines for Coding Jaundice Follow-up Encounters
Key: Treat 'bili checks' as sick, not well visitsYou can avoid incorrectly using up o... Read more
Top-Notch Telephone Management for the Medical Office
Presented by Victoria JacksonThe following supplement to Pediatric Coding Alert is the tra... Read more
Simple Tool Fights Code Nonrecognition
Question: An insurer that we frequently bill rejects new vaccine CPT 90714 because the co... Read more
Apply Standard Terms to ICD-9 Codes
Question: Are there definitions to the 995.5 diagnoses, such as 995.59? Also, what are th... Read more
Don't Stress About Modifier 57 Nonuse
Question: I noticed modifier 57 in CPT Appendix A. As a general pediatrician, I have rarel... Read more
Rocephin Shot Requires 2 Codes
Question: For a Rocephin injection, is it better to use J0696 or 90788? Insurers pay only ... Read more
You Be the Coder:
Find Failed Hearing Test's Correct ICD-9 Code
Question: A child came in for a hearing exam in which the pediatrician found normal test... Read more
Changing Newborn Status Warrants Additional Same-Day E/M Coding
Report sick visit when baby becomes ill after normal exam You may be undercoding infa... Read more
5 Forgotten In-Office Procedures Can Boost Your Botton Line
Bonus: You can charge a separate E/M service in addition to these surgeries Summer may ope... Read more
This Series Gets You Beyond 99211 for Nurse Counseling
Double your education reimbursement with assessment/intervention codesYou can boost reimbu... Read more
Here's an Easy Way to Make Sense of Health Behavior Terms
  Match assessment/reassessment/intervention cases to correct 96150-96155 codeIf... Read more
Use Documentation to Appeal 96110 Denials
Question: One of our insurance companies started bundling CPT 96110 into the well visit c... Read more
Look to 95004-95078 for Allergy Testing
Question: When we perform allergy testing, we bill CPT 86003 . Should we instead use 95004... Read more
Report E/M Code for Taping
Question: A pediatrician taped a child's injured fingers to provide stability. How should ... Read more
Distinquish Between 2 Pneumonia Vaccines
Question: How should I report a Pneumovax vaccine that we administered to a 9-year-old pat... Read more
Try Coding Telephone Calls
Question: Due to the large volume of non-emergent calls our pediatricians receive after 10... Read more
Apply No Age Limit to Feeding Difficulties Code
Question: Until what age of infant can I report feeding difficulties with 783.3 ?Kansas Su... Read more
You Be the Coder:
You Can Code ED Services 3 Ways
Question: An emergency department (ED) physician requested that a pediatrician see a patie... Read more
New ICD-9 Codes End Lumping Neonate Meconium Under 770.1
Update your autumn superbill with an extra digit for dehydration, 'no-vaccination... Read more
These 10 V Codes Tell Why Child Didn't Receive Vaccination
Laminate this fall's guide to top pediatric diagnostic changesTake advantage of decreased ... Read more
Don't Let Insurers Pay Less Than AWP for 90734
 Experts offer 3 strategies for upping your Menactra reimbursement Advanced planning... Read more
Go to AAP Web Site for Menactra Letter
You can access the AAP's letter encouraging Menactra coverage and reimbursement from the A... Read more
Reader Questions:
Challenge 99431-Consult Bundle
Question: Pediatrician A performs a newborn exam in the hospital and bills 99431. Later on... Read more
Reader Questions:
Report Each Twin's Services
Question: How should I code subsequent hospital care of normal newborn twins whom an ob-gy... Read more
Reader Questions:
Use Unlisted Code for Second Observation Day
Question: I've heard that I can bill the "middle" day of observation as an outpatient offi... Read more
Reader Questions:
All Staff Can Perform History Element
Question: My coworker thinks a pediatrician must take a patient's history. But I think a n... Read more
Reader Questions:
Re-Examine Critical Care-Test Denial Claims
Question: When we report CPT 99291 for in-office critical care in addition to influenza a... Read more
You Be the Coder:
Should You Code Attempted Screen?
Question: When my registered nurse (RN) attempts to do an audio or vision screen, but the ... Read more
We'll Show You How to Save Time Obtaining Medical Supply, Drug Payments
Stop using 99070 as a catchall materials code Boost your injection, repair, splint and... Read more
These Common Pediatric HCPCS Codes Will Ease Reporting of Supplies
  Clip and post this guide to medical materials, injection medication charges ... Read more
Pediatricians Often Do This Work But Don't Take Credit for It
Not documenting all the history and exam could cost $30 per visit Two tips will help you... Read more
Get to the Heart of 99213 and 99214's Differences
One more HPI and one PFSH element could bump that encounter up a level If you document ev... Read more
Training Corner:
Pull Out This Month's 'Destroy Downcoding' Lesson
Staff can test their 99213-versus-99214 skills You can educate pediatricians, medical ass... Read more
Masterful CPT Coding to Capture All Revenue
Masterful CPT Coding to Capture All Revenue Presented by Kristine Eckis The followi... Read more
Reader Questions:
Use Screening, Not Vaccine Dx With TB Test
Question: We are trying to link the purified protein derivative (PPD) tuberculosis test to... Read more
Reader Questions:
Observation POS Is Always Outpatient
Question: A pediatrician admitted and discharged a patient to observation status for 12 ho... Read more
Reader Questions:
Include Nasal Swab in Pre-Flu Test Work
Question: A pediatrician performs the QuickVue Influenza test in the office. Should she co... Read more
Reader Questions:
Well Visit Doesn't Include Screens
Question: During a 4-year-old child's annual preventive medicine service, the pediatrician... Read more
Reader Questions:
Try 99078 for Group Asthma Education
Question: Our pediatricians offer a monthly asthma education service to current patients... Read more
You Be the Coder:
Suture Removal Code Depends on Insurer
Question: A child on Medicaid comes in to have stitches removed that an emergency depart... Read more
Success Story:
You Can Get Paid for Same-Session Teaching, Nebulization
Action: Designate 94664 as a distinct procedural service To obtain inhaler demonstration ... Read more
Case Study:
Test Your 'Unrelated' Versus 'Separate' E/M Modifier Skills
Hint: Modifier -24 or -25 depends on circumcision, service date To choose what modifi... Read more
Vaccine Counseling Code Reports Keep Rolling In
Submit 90465-90468 to NJ MCOs, not to Georgia Medicaid More insurers are accepting the... Read more
Reader Questions:
Group Specialist Doesn't Affect Status
Question: Is a patient a new or an established patient when a physician in one specialty t... Read more
Reader Questions:
Use Separate ICD-9 Code for Other Screenings
Question: At a child's 1- and 5-year checkups, we perform a screening urinalysis and compl... Read more
Reader Questions:
Expect More Money From In-Office Procedure
Question: What is the difference between facility and nonfacility relative value units (RV... Read more
Reader Questions:
Identify Each 'PKU' Test With V Code
Question: A nurse does a heel prick to collect a sample for phenylalanine (PKU). Which dia... Read more
Reader Questions:
Count Dermabond as Simple Repair
Question: I repaired a child's lacerations using Dermabond in three separate places on the... Read more
You Be the Coder:
Pelvic Exam Code Hinges on Reason, Payer
Question: I perform a pelvic exam with a preventive medicine service. May I separately rep... Read more
2 Wart Removal Notes Help You Identify Separate E/M
Charge 9921x-25 when these elements stand on their own The next time you're staring at a ... Read more
Find Out Which Lesions You Should Classify as 17000 Versus 17110
Clip and save your guide to 5 common lesion diagnosesWhen you remove a plantar wart, a whi... Read more
Before You Code Sick Newborn Care, Know These Concepts
2 scenarios pinpoint who requires additional training Identify who on your staff should s... Read more
Report Old Vaccine Shot Admin Or Face Invalid Code Rejections
Some payers suggest using 90471-90472, not 90465-90466 You've done everything you should ... Read more
Publishers Add Instructions to ICD-9 Manual
Be careful that you don't assume all ICD-9-CM directives come from ICD-9.   I... Read more
Reader Questions:
Use 11750 for Ingrown Toenail Removal
Question: A patient presents for a follow-up of an ingrown toenail. The pediatrician finds... Read more
Reader Questions:
CPT and Payer 99050 Start Times May Differ
Question: We have posted office hours from 8 a.m. to 4:30 p.m. When may we use CPT 99050 ?... Read more
Reader Questions:
Code 16020 Includes Initial Dressing
Question: A pediatrician sees a child with first- and second-degree burns on her hand. The... Read more
Reader Questions:
Check Whether Insurers Will Accept New Td Code
Question: My pediatrician wants to purchase preservative-free tetanus diphtheria (Td) vacc... Read more
You Be the Coder:
How to Code Parent-Only Session
Question: A pediatrician counsels a patient's parent for an hour regarding the child's sch... Read more
AAP Reveals When You Should Bill a Nurse Visit With Vaccine Administration
Report E/M for encounter that goes beyond these staff servicesThis just in: You should res... Read more
Your 99211-25, 9047x Notes Should Look Like This Entry
Test whether your separate-encounter coding is up-to-par If you question whether an E/M se... Read more
Nurse Visit Documentation Must Include 6 Items
Look for CC, problem to justify separate E/M service from administrationTrain staff to rep... Read more
Let Non-Critical Infant's Daily Condition Drive Inpatient E/Ms
Abnormal findings trigger shift from newborn to hospital care codesKnowing when and how to... Read more
Are You Ready to End Your E/M-Guideline Confusion? We Can Help
Use CMS' responses to our questions to report correct E/M levels Like many coders... Read more
Bonus Question:
Improve Your Prescription Drug Documentation
Find out what CMS has to say about the management options categoryCalculating a patient's ... Read more
You Be the Expert:
Should You Factor Patient's Status?
Question: During an office visit, my doctor performed an expanded problem-focused history,... Read more
Insurers May Bundle Handling Fee With Office Visit
Question: Payers are not reimbursing 99000 for cultures. Am I using this code correctly?Id... Read more
Don't Separately Bill Oxygen
Question: A pediatrician administers oxygen to an office patient who has a severe asthma a... Read more
Procedure's Reason May Solidify Separate E/M
Question: If pediatricians always perform a catheterization on an infant who needs a clean... Read more
Codes 90465-90468 Require Counseling Documentation
Question: The February Pediatric Coding Alert article "This 3-Point Checklist Helps You Us... Read more
Let the Elements Drive Your History Documentation
Question: The chart that physicians use to select the level of history includes identifier... Read more
You Be the Coder:
Determine Follow-up ED Patient's Status
Question: A pediatrician saw a patient whom our pediatric group never previously treated i... Read more
This 3-Point Checklist Helps You Use the Right Vaccine Admin Code Set
Rule: Revert to 90471-90474 when encounter doesn't meet 90465-90468's age, counseling crit... Read more
New Admin Codes Mirror Old Codes' Delivery Methods, Add-on Rules
Insider tip: You can choose between 90465-90468 the same way you choose between 90471-9047... Read more
CPT 2005 Quiz:
Test Your 90465-90474 Coding Skills
Although CPT Codes 2005 will complicate vaccine administration coding, this quiz will he... Read more
You Should Start Using Specific Neb Med, RSV Codes
Make sure you update Albuterol, Levalbuterol and respiratory syncytial virus (RSV) test ... Read more
2005 Fee Schedule Shocks Peds With Immunization Admin Pricing
Rate hike may offset code value declines A small increase in the 2005 fee schedule conver... Read more
Reader Questions:
Existing Problem May Warrant Separate E/M
Question: Does a pediatrician have to treat a new problem in order to bill a modifier -25 ... Read more
Reader Questions:
Code 278.00 Can Cause Payment Problems
Question: Insurers keep denying claims with diagnoses that indicate high body-mass index... Read more
Reader Questions:
Don't Assume All Codes Include Related Supplies
Question: In the January 2005 Pediatric Coding Alert, the reader question "Nebulizer, Vacc... Read more
Reader Questions:
You May Need 2 Modifiers on Infusion Claims
Question: May I report an office visit code in addition to hydration therapy code 90780? M... Read more
Reader Questions:
Bill Surgical Clearance Request as Consultation
Question: A surgeon sends you an established 1-year-old patient with chronic otitis media ... Read more
You Be the Coder:
Encounter's 99211 Eligibility Hinges on E/M
Question: After calling for a refill, the parent of a 6-year-old with attention deficit di... Read more
Your Admission Interpretation Could Limit Your Assess-and-Discharge Code Use
Secret: Look to exam, discharge date - not birth date - when assigning 99435 Despite conf... Read more
Appeal Modifier -25 Denials After You Take These 4 Steps
Solid chart note and payer's rule will help you win payment What should you do when a pay... Read more
Refresh Your Winter-Germ Detection Filing Skills
This chart helps you get the right 80000 series code for over 20 in-office test brands ... Read more
Tots N Teens Is in Hoffman Estates
The December 2004 Pediatric Coding Alert article  "What Flu-Shot Component Is Costing... Read more
Correction: The January 2006 Pediatric Coding Alert article "Update Neonatal Care Continuu... Read more
Reader Questions:
Nebulizer, Vaccine Include Inherent Supply
Question: May a pediatrician's office bill a syringe code with a vaccine administration co... Read more
Reader Questions:
You May Count Nurse Administration as 90465
Question: If a pediatrician provides the counseling and steps out of the room during the a... Read more
Reader Questions:
2 Steps Combat E-Code Rejections
Question: Is it important that I use the E codes? Insurers keep rejecting claims that cont... Read more
Reader Questions:
CPT Proves Rep's New Patient Definition Wrong
Question: A provider insurance representative recommended at an in-house seminar that when... Read more
Reader Questions:
Check 3 Details Before Appealing Rocephin Denial
Question: An insurer denied a Rocephin shot that I reported as JO696 with a diagnosis of R... Read more
You Be the Coder:
How to Code a 'Walk-out' Annual Exam
Question: A 16-year-old girl presents for a well-child preventive medicine service with a ... Read more