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Pediatric Coding Alert

CPT Update:
Identify Initial Sick Newborn Care Without Using a Hospital Code
CPT 2008 fills the 99295-to-9922x gap Tired of undervaluing your initial assessment o... Read more
Pre-Empt Catheter Denials by Adding 59 for Specimen
CCI makes cath part of LP--nail down the exceptionsA new far-reaching CCI edit could stop ... Read more
Stop Spreading Yourself Thin With Team Conferences
You'll have 3 new codes for ADHD school meetings, vent mgmt issues and moreDon't have time... Read more
Correction:
Use 90472 for 2nd IM Admin
When administering a second intramuscular (IM) immunization without physician counseling, ... Read more
READER QUESTIONS:
Pay Attention to CPO Month, Not Day
Question: Should I report care plan oversight services per month or per 30 days?Florida Su... Read more
READER QUESTIONS:
Is There an Eye Wash Code?
Question: A 2-month-old baby's parent brought her into the office with a feared complaint ... Read more
READER QUESTIONS:
Look at Transferring Patient's Time Frame
Question: A pediatrician is new to our practice from another practice in town. Some of her... Read more
READER QUESTIONS:
NPs Can Use MD Codes
Question: When a nurse practitioner calls a patient instead of the pediatrician, can I use... Read more
READER QUESTIONS:
Consult Medicaid on Interpreter T Code
Question: Previous Pediatric Coding Alerts have mentioned that CPT does not contain an int... Read more
READER QUESTIONS:
Clip and Post Your Minute Call-Code Guide
Question: How many minutes will the new telephone call codes contain?Ohio SubscriberAnswer... Read more
You Be the Coder:
Post-Discharge Well-Baby Visit
Question: One of our pediatricians sees a newborn for the first time in the private practi... Read more
Discover the Simpler Way You'll Pick Telephone Call Codes in 2008
Surprise: E-visits become mainstream with CPT Category I codeHas the imprecise matching of... Read more
Stop Seeing Stars When Deciding E/M-25 + Minor
Rule: Scheduled wart removal, I&D = procedure onlyYou need a new system to determine w... Read more
Coding 90657 When You Gave 90655 Costs You $9
Focus on 2 details to capture the flu vaccine pay you deserveIf you're losing money on flu... Read more
Pinpoint the 9065x Code You Need in 1 Shot
Timesaver:  Link the flu vaccine with the right CPT code every time using this tableN... Read more
Correction:
Use 90472 for 2nd IM Admin
When administering a second intramuscular (IM) immunization without physician counseling... Read more
READER QUESTIONS:
Continue Status Through 1st New Encounter
Question: Could you clarify how to code a new patient visit during which the patient comes... Read more
READER QUESTIONS:
Your Peers Charge for FMLA Completion
Question: I saw a mother of twins who requested advice on dealing with both babies' needs,... Read more
READER QUESTIONS:
Appeal 99143-99145 Denials With New Policy
Question: When I provide moderate sedation in addition to a procedure, such as a spinal ta... Read more
READER QUESTIONS:
2008 Brings 6 New Vaccine Codes
Question: Will there be any new vaccine codes for 2008?Tennessee Subscriber Answer: Yes. T... Read more
READER QUESTIONS:
Use V15.86 When Child Had a Recalled Toy
Question: What V code should we use for lead screenings that parents request due to the nu... Read more
You Be the Coder:
Catch-Up Shot Session
Question: At an 18-month preventive medicine service, the pediatrician noted that the todd... Read more
Find Out the Newborn Care Codes You Could Be Missing
Time-saver: You can ignore hospital dates when selecting 99435 If your newborn-inpatient... Read more
Capture More for Consult Without Raising Payers' Ire
CPT allows 99241-99245 when RN requests opinion Increased consultation R's means you'... Read more
Get Up-to-Speed on a Consultation's 5 R's
Clip and save your 99241-99245 requirement cheat sheet If you still think of three R's w... Read more
Prove Your RN Did 94664 to Any Doubting Authority
This tool makes documenting MDI instruction a breeze Are insurers denying 94664 or bundl... Read more
Reader Question:
Who Can Teach Nebulizer Use?
Question: Can we bill for nebulizer teaching that a certified medical assistant (CMA) or ... Read more
Reader Question:
Boost E/M Level When Staff Interpret
Question: We are a very busy pediatric office with four staff pediatricians, three of who... Read more
Reader Question:
Simplify Critical Care Time Recording
Question: I've heard about the importance of documenting critical care time. As a pediatr... Read more
Reader Question:
Consider Modifier for MD Suture Removal
Question: Insurers sometimes deny suture removal even though our pediatricians did not re... Read more
Reader Question:
Avoid Paybacks for Cloned Documentation
Question: I often use previous electronic medical record (EMR) charts with the same chief... Read more
You Be the Coder:
Omit QW on These Test Codes
Question: Do I need to use modifier QW on all lab tests? Louisiana Subscriber   An... Read more
Discover Do's and Don't of Coding Diet/Weight Assessments
Compliance with new AMA recommendations doesn't necessarily equate to more pay, experts ... Read more
Should You Use New Albuterol Q Codes?
Let payer steer your inhalation solution supply coding Before you bill for your next neb... Read more
Break Down Globulin Injection for Some Payers
CMS replaces J1567 with 4 product-specific Q codes If your payer decides to follow CMS' H... Read more
Are You Cutting $30 from Established Patient Visits?
Analyze your E/M patterns to fix this money-drainer Your coding pattern could cost you mo... Read more
What's the Difference Between 99212, 99213 and 99214?
Clip 'n' save your mid-level office visit breakdown You can't use just history and examin... Read more
Reader Questions:
Worked-in Walk-ins Rule Out 99058
Question: A mother calls and reports her baby is having trouble breathing. A nurse recogn... Read more
Reader Questions:
Use 9920x After Involved 99381
Question: A pediatrician sees new patient twins for their four-month well visit. Chart sh... Read more
Reader Questions:
UHC Reduces Problem-Portion Pay
Question: On claims containing a preventive medicine service and an office visit code, an... Read more
You Be the Coder:
Splinter Removal Per Removal?
Reviewed on April 29, 2015 Question: A pediatrician removed 15 splinters. Should I b... Read more
Avoid Undercoding ADD/ADHD Sessions by Using Coding Continuum
Ethically boost assessment visits by $61 when you find this documentation You can capture ... Read more
Should You Report ADD/ADHD Visit During a Well Check? Let 3 Common Cases Be Your Guide
We'll show you which disorder-related services warrant separate reporting When a patient c... Read more
Let Visit's Focus Determine Newborn Encounter Coding
5 scenarios walk you through using V20.2 versus a problem dx Not sure which diagnosis to u... Read more
Reader Question ~ Your Pocket Prefers 12001 to G0168
Question: I found a HCPCS code for Dermabond. Can I use G0168 instead of a CPT wound repai... Read more
Reader Question ~ Check Payer's Modifier 57 Policy
Question: When a pediatrician refers a patient for surgery, can I use modifier 57?Georgia ... Read more
Reader Question ~ Limit 99354-99355 to Time-Based Services
Question: A pediatrician saw a child in the hospital under observation and spent three hou... Read more
You Be the Coder ~ Hair Strangles Toe:
Find the ICD-9 Code
Question: At a preventive medicine service, a pediatrician found that the infant had a hai... Read more
Upcoming Diagnostic Changes Revealed:
Alter Your Classification of This Common Childhood Disease
ICD-9 2008 brings changes for 2 herpesvirus infections, recognizes infant botulismWhen new... Read more
Find Out When to Report 2 Allergy Symptoms, 1 V Code
You won't code 'runny nose,' 'caregiver' every time you see oneAlthough new entries for "r... Read more
Plan Your Sports Physical Coding to Keep Documentation In-Line
Your notes will need to reflect the option you chooseBefore you attend to your next sports... Read more
Consider a Special Service Code in These Scenarios
Catch: July 4th can fall under 99050 or 99051--your hours make the differenceYou can't get... Read more
READER QUESTIONS:
Note Exceptions to the 1-E/M-per-Day Rule
Question: I was told to bill only one E/M service per calendar day. Does this apply to all... Read more
READER QUESTIONS:
Lavage Doesn't Count as 69210, AMA Says
Question: The Vol. 10, No. 5 Pediatric Coding Alert article "Greenlight 69210 Only When Yo... Read more
READER QUESTIONS:
Fee Schedule Gives Credence to 99173
Question: A consultant suggested we use modifier 25 to overcome denials for 99173 and 8100... Read more
You Be the Coder:
Leg Pain at Well Check
Question: An established 2-year-old patient presented for a well child checkup. The patien... Read more
Do Your On-Call Arrangements Negate Billing 99295-99300?
A different 'direct supervision' definition applies to neonates requiring critical/intensi... Read more
Use 25 to Overturn Denial of OV With 95115 or 95117
Medicare now allows same-day E/M service and allergy injection -- and your payers should, ... Read more
Give Yourself Leeway on Coding Fracture or Casting
You can ethically boost claims $80 to $125 by reporting treatment instead of splint/stra... Read more
Reader Questions:
Frequent Headaches: 99214 or 99215?
Question: Which CPT code should I use for this case: An established 7-year-old patient pre... Read more
Reader Questions:
Is New 82247 Test Approved for the Office?
Question: May I perform the new total bilirubin test in the office?Florida Subscriber Answ... Read more
Reader Questions:
250.01 Makes 99401-99404 Inappropriate
Question: Can I use 99401-99404 when a pediatrician talks to a patient about diabetes?New ... Read more
Reader Questions:
Modifier May Unlock 94760 Payment
Question: Is there any secret to getting payment for pulse oximetry test code 94760? Our i... Read more
Reader Questions:
Use 99241-99245 When Preoperative Meets 3 Criteria
Question: What is the CPT code for a pre-op exam?New Jersey Subscriber Answer: No CPT code... Read more
You Be the Coder:
Tick Removal: FBR or E/M Code?
Question: A patient with a tick embedded in his shoulder came to our office. The pediatric... Read more
Greenlight 69210 Only When You Check Off 2 Items
Warning: Ear wash doesn't meet 69210's instrumentation requirement If you bill 69210 for c... Read more
Let AMA-Endorsed 380.4 Definition Steer Your 69210 Coding
These considerations support cerumen impaction Not sure what constitutes impacted cerumen?... Read more
Hone Your Hx, MDM Skills With This Case Study
Interpretive services can stack up to a higher E/M level When a language barrier causes an... Read more
Use This Tool to Add $-Making Procedures to Your Superbill
Are you minimizing revenue by using an E/M instead of a procedure code?  Stop insurer... Read more
Reader Questions:
NCCI, Not CPT, Bundles E/M With 90772
Question: A pediatrician saw a child with severe bilateral otitis. Because this was her ... Read more
Reader Questions:
Use 'New' Sedation Codes for Hospitalist
Question: The outpatient department sometimes requests that a physician from our hospitali... Read more
Reader Questions:
Find Out Whose Calls to Tally in 99374-99375
Question: Should I include telephone calls that a nurse makes in care plan oversight servi... Read more
Reader Questions:
Get System Credit With This Phrase
Question: Do I need to list "No" for each negative review of systems (ROS)? Ohio Subs... Read more
You Be the Coder:
Discover Dermabond Coding How-to
Question: A pediatrician uses Dermabond to close a patient's 1.0-cm cheek laceration. Shou... Read more
Stop Hunting for an ICD-9 Code for RAD
Reviewed on May 11, 2015 The problem is with the term, not the code If you’r... Read more
Give Yourself Credit for E/M Service in These 4 Instances
Hint: When you can't immediately identify the problem, 9921x-25 might be in order Gain th... Read more
Are You Using Time-Based Coding to Your Advantage?
3 tips show you how to count minutes and safeguard your code selection When coding based ... Read more
Capture Extra Time 2 Ways
These rules govern reporting of beyond-guideline time Not sure how to get paid when you e... Read more
Correction:
Reflect Phenergan With HCPCS Code J2550, Not J2250
When coding for Phenergan, don’t mix up the “25” with a “22.&rdq... Read more
Reader Questions:
Take These Steps to Show PFSH Checked
Question: Can I count past family social history (PFSH) items that I record using a sheet... Read more
Reader Questions:
Limit 99293-99294 to Patients Through 24 Months
Question: A pediatrician sees an 8-year-old patient in the pediatric intensive care unit.... Read more
Reader Questions:
Let 4 Rules Guide Your 90465-90474 Coding
Question: The February 2007 Pediatric Coding Alert "You Be the Coder: Commit This Adminis... Read more
You Be the Coder:
Check 2 Items Before Coding Bilateral
Question: What modifier should I use for “bilateral procedure”? Should I use... Read more
Get the Inside Scoop on How Revisions of Lesion Destruction Codes Impact You
Plantar wart removal now falls under 17110 If your encounter sheet contains only 17000 and... Read more
Match Lesion Destruction Diagnosis and Procedure Codes Like a Pro With This Cheat Sheet
      All 'Verruca' codes fall under one CPT code but have different ICD-9... Read more
Follow This Step-by-Step Guide to Using Modifier 25
5 tips walk you through reporting dual-service claims When a claim requires modifier 25, t... Read more
Take the Mystery Out of Where to Pencil in the '25'
Trace 2 preventive medicine service claims from start to finish You've identified which CP... Read more
READER QUESTION:
Solve 94640 Denial Using These Tools
Question: I reported a sick visit, in which a strep test and nebulizer treatment were pe... Read more
READER QUESTION:
Stick With Status Quo for Rocephin Shots
Question: Has the code for Rocephin (ceftriaxone 500 mg) changed in 2007? Should I still... Read more
READER QUESTION:
Use 18 Years as V20.2 Cutoff, CMS Says
Question: A 17-year-old patient comes in for a preventive medicine exam. We use CPT code 9... Read more
READER QUESTION:
Check With Insurer for 90281 Coverage
Question: When we give immune globulin (90281) for traveling out of the country, is the im... Read more
READER QUESTION:
Look at Time When Selecting 99238-99239
Question: Some newborn discharge claims contain 99238, and others list 99239. Which is cor... Read more
READER QUESTION:
Give Dual Credit for ECG Order and Review
Question: The Marshfield Clinic's audit tool awards two credits for independent visualizat... Read more
YOU BE THE CODER:
Does CPT Contain Connor's Code?
Question: Our pediatricians use the Connor's Questionnaire to help determine whether a pat... Read more
Consider 2 Scenarios for Reporting an Office Visit and Monthly Synagis Shot
Most pediatricians want to see these patients, making 99212-99215 appropriate Because infa... Read more
Rethink Your Coding of OVs After Well Checks
CPT Assistant says to maintain new patient as new for both services When considering patie... Read more
NEWS BRIEF:
Delight in 5 Percent Boost to 2007 Fee Schedule
Congress votes to avert CF payment cut and maintain 2006 rate Your payment picture for 20... Read more
Should You Report That Flu Test Once or Twice?
Lab expert reveals secrets of coding Quickvue, Binax products Use this simple guide to det... Read more
READER QUESTION:
Use Respiratory Dx for Wheezing
Question: Concerning the coding of acute bronchospasm (519.11), when is it appropriate to ... Read more
READER QUESTION:
Go Online for Current CLIA List
Question: How can I determine if a product is CLIA-waived?Texas Subscriber Answer: You can... Read more
READER QUESTION:
Is There a Code for Probe Sheaths?
Question: We are using many covers for temperature taking and wondering if there may be an... Read more
READER QUESTION:
Choose J Code Based on Drug, Not Name
Question: Publications list the code for Phenergan as J2250 (Midazolam hydrochloride). Wou... Read more
READER QUESTION:
Combat 461.9 Denials With Documentation
Question: Would you please help me with the coding of 461.9 (Acute sinusitis, unspecified)... Read more
READER QUESTION:
Report SureSight With Regular CPT Code
Question: Should I use 0065T instead of 92015 for a SureSight vision screening?New Mexico ... Read more
READER QUESTION:
Use 99221-99223 for Nonpediatric PICU Admit
Question: After an 11-year-old patient went to the emergency department (ED), our pediatri... Read more
READER QUESTION:
Bill Asthma-Attack Portion Separate From Well Portion
Question: After receiving a preventive medicine service, the patient has an asthma attack.... Read more
YOU BE THE CODER:
Remember This Administration Rule
Question: After a pediatrician provides vaccine counseling for an infant, a nurse administ... Read more
Look Forward to a Bigger Piece of the Payment Pie for Acute E/M Services
Bad news: 2007 fee schedule decreases circ, lumbar puncture total RVUsThe 2007 Physician F... Read more
Anticipate an Initial RVU Increase Coupled With an Overall Pay Decrease
      Our financial experts do the fee schedule number crunching for youWh... Read more
CASE STUDY:
Take 3 Steps to Determine Reportable DR Procedures
Tip: Separate site warrants separate pay If you don't know the exceptions to the critical ... Read more
READER QUESTION:
Determine 'Significant' With 5 Questions
Question: How can I tell if a problem found at a preventive medicine visit is considered s... Read more
READER QUESTION:
Use Modifier to Report Inhalations
Question: When I bill two units of 94640, insurers deny the second charge as duplicative. ... Read more
READER QUESTION:
Code Prenatal Visit Based on Type
Question: We do prenatal interviews in which expectant parents meet with a pediatrician to... Read more
READER QUESTION:
Related Aftercare: 99213 or 99024?
Question: After fracturing a wrist, a patient returns for a follow-up visit in 10 days. On... Read more
YOU BE THE CODER:
Code a Recheck-Turned-ADD Discussion
Question: An established patient presents in the office for an otitis media recheck. The p... Read more