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Pediatric Coding Alert

CPT 2009:
4 Pointers Help You Find Relocated Newborn, Pediatric Care Codes
Your days of flipping through unrelated pages are over.You'll have an easier time putting ... Read more
Revision May Spell 'Relief' for 99440 Denials
New resuscitation code stresses separate site.If your neonatal group is plagued with newbo... Read more
Weigh Dollars Vaccine, Tobacco Counseling Options Can Deliver
Let condition, coverage steer selection.Before you write off time you spend providing smok... Read more
Avoid Negative 90772 Attention
This action plan will make your Rocephin, Decadron claims shine.Although therapeutic injec... Read more
Reader Question:
This Modifier Isn't a Helping Tool
Question: When the same physician gives multiple vaccines at the same encounter, should I ... Read more
Reader Question:
Meet 3 R's to Boost Pre-Op Pay
Question: A surgeon asked a pediatrician for pre-op anesthesia clearance on a new patient.... Read more
Reader Question:
Versus' Dxs Require Follow Up
Question: In an outpatient physician setting, the pediatrician wrote only "URI vs. Pneumon... Read more
Reader Question:
99444 Requires Numerous Criteria
Question: Does an Internet office visit trigger a copay?Ohio SubscriberAnswer: Using 99444... Read more
Reader Question:
Include This Info in ROS Update
Question: A pediatrician sees a patient for a problem two weeks after previously treating ... Read more
Reader Question:
Report 87804 Per Result
Question: Our office has been billing 87804 (flu testing) as a quantity of 1 until recentl... Read more
You Be the Coder:
Make $50 More for Hematoma I&D
Question: I spent a while poking at a patient's blood clot to get it to break. I put on pr... Read more
Try 4 Strategies to Score 100 on Sports Physical
Parents can choose covered annual or self-pay exam.If you're at a loss for how to code a s... Read more
Bust the AM, PM Nebulizer Treatment, Training Myth
You'll rethink 94640, 94664-59 thanks to these experts' explanations.Misinterpreting modif... Read more
Before Coding 94664, Check Off These Items
Chart must show training's medical necessity to make appeal worthwhile.You can challenge t... Read more
Circle 'Moderate' When MD Weighs Medication Risk
Giving samples involves same process -- just without paper.You might not be giving yo... Read more
Factor Elements, Components + Med Management to Check E/M
You should consider risk only a part of level selection.Your pediatrician's level won't ho... Read more
Pros, Cons of Same Day E/Ms
Question: Does reporting an established patient preventive medicine service and a problem-... Read more
Get Payers to Up Consult Pay
Question: An insurer is paying us less for consultations than established patient office v... Read more
Troubleshoot Wart Removal Denial
Question: I received a denial from Medicaid for 99214-25, 078.19, and 17110. The carrier... Read more
READER QUESTIONS:
ICD-9 Code for 'Gross Motor Delay'
Question: A pediatrician I code for writes "gross motor delay." Unfortunately, her office ... Read more
Put Your 99477 Payment on the Proper Path By Sticking to These Guidelines
Newborn post-day-1 claims should contain subsequent intensive care, not initialYou've got ... Read more
Realize Day 1 Can Contain 99431-25, 99477
Code 99477 can be second E/M on initial dayIf a normal newborn becomes sick on day one fol... Read more
Get the Inside Scoop on Selecting Time-Based E/M
Guideline determines if minimum, average appliesThink 35 minutes spent on a counseling-dom... Read more
Ease Well-Visit Coding With V20.2 Across the Board
Beware: Payers may force you to use 'acceptable' dxIf you've been struggling with when to ... Read more
READER QUESTIONS:
Two Hospital Visits: 1 E/M or 2?
Question: A private payer representative informed my doctors that they can bill for more... Read more
Reader Questions:
Is There an Attempted Procedure Modifier?
Question: When a certified medical assistant (CMA) performs a screening and cannot get a r... Read more
Reader Questions:
Charge Adoption Evaluation to Parent/PPO
Question: We have a pediatrician who specializes in international adoptions. When a family... Read more
Reader Questions:
Connect Saturday Code to Hours, Not Dx
Question: Our office is open on Saturdays. What ICD-9 codes would the claim require to use... Read more
You Be the Coder:
Strep Bundle Signals Larger Problem
Question: Our pediatric office is using 86403 for rapid strep tests and receiving denials ... Read more
Break Down Fracture Care to Get Paid for Your Piece of the Pie
These 4 real-life scenarios test your globalization versus itemization skillsJust because ... Read more
Stop Postop Fracture Care Double Dips With Inside Tips
You've got to teach your ED/clinic to sharePutting modifier 55 on fracture care codes can ... Read more
ICD-9 Update:
Change Plantaris Wart Code for Specific ID
Pediatric expert shows you the diagnoses to add to your superbillYou'll add only the diagn... Read more
Cautionary Tale:
Protect Time-Based Pay in 2 Easy, But Critical, Steps
Omitting this detail could cut a 99214 to a 99213If time-selected E/M documentation does n... Read more
READER QUESTIONS:
Do These Calls Fall Within 99441-99443?
Question: A parent leaves a message seven days after the previous related E/M and wants ph... Read more
Reader Questions:
Is Consult + Circ OK?
Question: Other pediatricians who do not perform circumcisions ask me to do the circumcisi... Read more
Reader Questions:
Treat Clinic As Office for Supervision
Question: I work in a clinic located in a hospital building. Can a nurse run an allergy sh... Read more
Reader Questions:
Do Dual Notes Require PE Reentry?
Question: On an electronic medical record (EMR), do I need to redocument the physical exam... Read more
You Be the Coder:
Check Location Before Coding ECG
Question: After obtaining a patient and family health history and doing a physical exam fo... Read more
ICD-9 Update:
Prepare to Expand Fever Diagnosis So Fall Claims Will Sail Through With Ease
Your 780.6 entry will soon require four more linesTo report a fever of unknown origin (FUO... Read more
Protect Incident-to NPP Pay With Added Phrase
Your NP can report service directly without satisfying criteriaYour pediatricians won't ha... Read more
Stop Hunting for HPI Rule With Inside Info
The AMA considers this element your pediatrician's dutyAlthough support staff might want t... Read more
Reader Questions:
Multiple Screens: 1 Code or 2
Question: A pediatrician performs two 96110s -- a PEDS and an ASAS. Can I report 96110 mul... Read more
Reader Questions:
Audit Quiz: How Many HPI in 'Dull Ache'?
Question: I'm auditing a note that states:"CC: A patient seen in the office complains of l... Read more
Reader Questions:
Include Spirometries in 94060
Question: We are looking into buying a digital spirometer. What is the difference between ... Read more
Reader Questions:
Tally 30+ Indirect Minutes for 99358-99359
Question: Through negotiations, some payers have agreed to cover non-face-to-face services... Read more
Reader Questions:
Check Hand or Foot Before Coding FBR
Question: Using a needle to make an incision, a pediatrician removed a wood splinter from ... Read more
Reader Questions:
Recoup Refused Vaccine Counseling
Question: We're spending a lot of time counseling parents on the importance of receiving i... Read more
You Be the Coder:
Include Anesthesia in 1 Circ Type
Question: When a pediatrician performs a neonatal circumcision without anesthesia, a consu... Read more
Report Reinstated Albuterol, Levalbuterol Codes to Avoid Denials
Payers are already accepting 'new' HCPCS 2008 J codesIf you're after a nebulization treatm... Read more
Check 4 Items Before Coding Inhalation Solution
Don't use J7611-J7614 if you mix med or use sampleAlthough albuterol and levalbuterol J co... Read more
Collect on Counseling, Calls by Using Waiver Basics
Modifier GA flags 99442 as patient's responsibilityAlleviating write-offs for noncovered, ... Read more
Reader Questions:
Avoid Routine Pap Carve Out With Prep
Question: Many of our female teenage patients prefer to return to see our female pediatric... Read more
Reader Questions:
Exam Interpretation Vs Bean-Counting
Question: Would our general pediatric practice benefit more from using the 1995 or the 199... Read more
Reader Questions:
How to Code Admit to Hospitalist
Question: A pediatrician sees an established patient in the office for high fever and dehy... Read more
Reader Questions:
Count the Note's Components for E/M
Question: I'm auditing a note that reads: "12-yr-old with new prob. Pharyngitis." There's ... Read more
Reader Questions:
Anticipate Nursemaid Elbow Diagnoses Next Fall
Question:  A child required reduction of a subluxed radial head. Is there a specific ... Read more
You Be the Coder:
Counseling for Obese Children
Question: Insurers aren't paying 99408-99409 (behavior change intervention) for a nutritio... Read more
Avoid 99173 Bundles by Offering Readily Paid VEP Vision Testing
This amblyopia screening tool has its own codeIf you want to test nonverbal patients for v... Read more
Get Paid for 95930 During E/M Using 2 ICD-9 Tips
Watch out: Sometimes a well-check diagnosis isn't the way to go You'll get pai... Read more
Case Study:
Try 4 Strategies to Deter 90472 Duplication Denials
These forms reveal legit multiple-IA billing methodsWhen faced with rejections for multipl... Read more
Reader Questions:
Should We Apply CCI Across the Board?
Question: We are a large multispecialty group. Some coders who file Medicare claims sugges... Read more
Reader Questions:
How to Make a Time Note Audit-Friendly
Question: When coding based on time, my pediatricians document the amount of time they spe... Read more
Reader Questions:
Antibiotic Points to But Doesn't Cinch 99214
Question: The risk management table lists prescription drug management as moderate risk. D... Read more
Reader Questions:
Treat Special Service Codes as Add-Ons
Question: Do we need to use a modifier when coding prolonged services or special service... Read more
Reader Questions:
Article Provides Ammo for 9944x Coverage
Question: A pediatrician talked to a mom who called in because her toddler's gum was stuck... Read more
You Be the Coder:
E/M or Nosebleed Code?
Question: A mother brought in her teenage son who had collided with another player in a so... Read more
Prevent Payment Loss on 90760, 90772 With This Bundle-Breaking Tool
CCI 14.1 forces you to get a handle on separate, significant serviceThe next time a patien... Read more
Expert Advice:
Ask 4 Questions to Spot Significant, Separate Service
Clip and save your modifier 25 use checklistEasily distinguish a significantly separate E/... Read more
CCI 14.1 Update:
Limit Nebulizer Treatment to 94640 or 94644
3 must-have edits prepare you for strapping, nebulizer, ECG denials & moreFind out whe... Read more
Advanced Lesson:
Restrict 99366, 99368 to Non-MD NPI Holders
Incident-to creates off-site hang-upsDon't let your staff attend school conferences unless... Read more
Reader Questions:
Prepare for 'UHC Meets CCI'
Question: I've heard that I'm going to have to start changing some of the codes that I bil... Read more
Reader Questions:
Reduce Consult Faxes by Striking First
Question: Specialists keep faxing our office consultation confirmation forms for us to com... Read more
Reader Questions:
Consider Flu Nasal-Wash Options
Question: Is there an appropriate "collection code" to report for performing the flu nasal... Read more
Reader Questions:
Will Law Portend Better 314.0x Coverage?
Question: I've read about the possible legislation that would disallow insurers from discr... Read more
Reader Questions:
How to Report Hearing Loss Unfounded
Question: A patient comes to us after failing a school hearing screen but passes our in-of... Read more
You Be the Coder:
Could Sepsis Care Fall Under 99477?
Question: A pediatrician cannot determine a newborn's gender. The physician contacts an en... Read more
Capture All 'Bright Futures' Services Using This Step-by-Step Guide
Well checks involve many extras -- which one are you forgetting to code?If you're not clea... Read more
Must-Have Chart:
Leave No Ancillary Service Unclaimed With This Bright Futures-CPT Crosswalk
Post your one-stop shop for well-check-related codesStop missing one or two codeable preve... Read more
Charge Allowed Inhalation Services With Coding Do's
Code 94664 specifies 4 devices -- but that's not the be-all listStop missing opportunities... Read more
Reader Questions:
E/M Is Best Bet for Suture Removal
Question: For suture removal, may I refer the patient to the facility that placed the stit... Read more
Reader Questions:
Squirmy Child Stops Screen
Question: We tried to do an audiogram with a patient, but we were unable to obtain it. Isn... Read more
Reader Questions:
Which E Code Goes First?
Question: A patient suffered a second-degree burn on his forearm due to his angry father p... Read more
Reader Questions:
Learn 2008 Conversion Factor -- for Now
Question:What is the conversion factor for 2008?North Carolina SubscriberAnswer: The conve... Read more
Reader Questions:
Code Initial Care at 1st Inpatient Visit
Question: A pediatrician admits a patient to observation on Feb. 22. The physician writes ... Read more
Reader Questions:
Zoom In on Fluorescein Use
Question: Our pediatrician performed a fluorescein staining for detecting a corneal abrasi... Read more
You Be the Coder:
Tally Cough, Cold, Wheezing History Note
Question: A pediatrician documents, "12-month-old here for evaluation of cough and cold sy... Read more
Case Study:
Limit Lead Poisoning Diagnosis to Positive Test -- or Risk Fraud Charges
Better way: A high-risk V code can remedy payment woesYou're going to have to use an extra... Read more
Paint a Rosier Financial Picture With 3 Fresh Tips
This practice was losing $32 per chest x-ray -- but not anymoreKeeping your practice from ... Read more
Steer Clear of Screening and Well-Check Modifier Mishap
Modifier 25 is the way to go with E/MsYou may no longer have the option of using modifier ... Read more
Reader Questions:
Can You Bill for Parents-Only Conference?
Question: An established patient's parents came in without their teenage son to discuss hi... Read more
Reader Questions:
Clip and Save Your 99477 Bundle List
Question: What services are included in the new neonatal initial hospital intensive care c... Read more
Reader Questions:
Avoid 99211 for MD Weight Loss Evaluation
Question: A mother brought an infant in three days after a hospital delivery for a nurse... Read more
Reader Questions:
Which Codes Are Missing From CPT 2008?
Question: I read that the CPT 2008 manual doesn't contain three new vaccine codes. Would y... Read more
You Be the Coder:
Do Butterfly Bandages = Repair Code?
Question: A mother brings her 10-year-old daughter to our office because the child fell fr... Read more
Obtain Elusive Screening Payment With These Methods
Which item is your well-check inclusion appeal pack missing?Before you throw in the towel ... Read more
Avoid Using 'Loophole' to Bill Routine OMs as 99214s
Surprise! CPT and CMS require medical necessity for all E/M visitsIf you fall for the "E/M... Read more
Clarification:
Check Law Before Extending Traditional MD-Only Codes
CPT doesn't offer the final word The Reader Question "NPs Can Use MD Codes" in Pediatric C... Read more
READER QUESTIONS:
Stick With 075 for EBV
Question: Should I code Epstein-Barr with new 2008 code 058.89 (Other human herpesvirus in... Read more
READER QUESTIONS:
Photoscreening Gets Category I Code
Question: I'm questioning our practice's use of 92015 for photoscreening. The procedure do... Read more
READER QUESTIONS:
Keep Coding When $$$ Don't Roll In
Question: When an insurance carrier does not pay for a code, should we still report it?Vir... Read more
READER QUESTIONS:
3 Ways to Code Suture Removal
Question: For suture removal, we found 15851. When a pediatrician removes sutures in the o... Read more
READER QUESTIONS:
Are Consult Requests Limited to MDs?
Question: A school nurse or teacher asks a pediatrician for an opinion on a child, and the... Read more
READER QUESTIONS:
Does 90634 + 90471 Require 51?
Question: Can you settle a dispute our office is having? Do we need to use modifier 51 whe... Read more
READER QUESTIONS:
Update Hospital Bladder Aspiration Code
Question: A pediatrician performs a suprapubic aspiration to obtain a clean urine specimen... Read more
You Be the Coder:
Code Tooth Decay Preventive Service
Question: Our pediatricians are considering offering in-office fluoride treatments as an a... Read more
Get These Facts Before Buying SureSight for Vision Screening
u Caution: Product info could misdirect you to 92015 If you're considering replacing tech... Read more
Ask 2 Questions Before Coding Chronic Condition
u Asthma scenario tests your dxs ordering skills A patient with asthma or diabetes always... Read more
CPT Update:
Capture Care Beyond 99223 With 99477
u Newborn care continuum gains middle tier You can confidently use a new tool in your i... Read more
Gain $178 for Increased 99477 Work
4 Vignettes pin down initial newborn care differences Initial newborn care codes pay from... Read more
Reader Questions:
Change 3 Disease Codes on Your ICD-9 Bill
Question: We're trying to get up to speed on the ICD-9 2008 diagnoses that became effecti... Read more
Reader Questions:
Don't Switch Your Modifier 25 Base Code
Question: On claims involving 99381-99385, 99391-99395 and 99201-99215, may we append mo... Read more
Reader Questions:
Protect Moonlighting Coding With Q6
Question: Can we use modifiers Q5 and Q6 for non-credentialed "moonlighting" physicians? ... Read more
Reader Questions:
Clip 'N' Save Your Synagis Coverage Guide
Question: Insurers keep denying 90378 with 765.10. How can I obtain Synagis payment? Texa... Read more
You Be the Coder:
Check 2 Criteria for Hydration in 2008
Question: A pediatrician at our urgent care center ordered intravenous (IV) hydration for... Read more