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Pediatric Coding Alert

CPT® 2012:
Say Hello to Car Seat Testing Codes Effective Jan. 1
Plus: You'll find clarification on developmental testing codes 96110-96111. Last year, co... Read more
CPT® 2012:
Keep An Eye on the Clock Thanks to CPT®'s Observation Care Time Guidelines
Plus: New otoacoustic testing codes could benefit your hearing-impaired patients. When... Read more
2012 Medicare Fee Schedule Cuts Could Affect Pediatric Pay
Many private payers follow these trends, so keep an eye on this issue as the year progress... Read more
OIG to Focus on Medicaid Overpayments, CCI Effectiveness in 2012
Watch out: Medicaid claims may face greater scrutiny in the coming year.Are you hanging on... Read more
ICD-10 Readiness:
Asperger's Will Have Its Own Code After Oct. 1, 2013
Check out how your autism coding options will change under ICD-10.If you've become accusto... Read more
Reader Question:
Diagnosis is Related to E/M Level, But Doesn't Dictate Code
Question: Our pediatrician saw an established patient with severe chronic allergies. The p... Read more
Reader Question:
Consider Symptoms When No UTIs Found
Question: Our pediatrician recently saw a patient who came in because she was grabbing her... Read more
Reader Question:
Take Note of Updated ADD Diagnosis Code Options
Question: I have just learned that ICD-9 V40.3 (Other behavioral problems) was deleted as ... Read more
You Be the Coder:
Do Consults Still Apply?
Question: In volume 14, issue 11 of Pediatric Coding Alert, you advised a practice re... Read more
Vaccine Products:
Fighting Denials for Male HPV Vaccines? Try These Strategies
Let staff know about carrier challenges, and prepare a waiver when necessary. Nearly t... Read more
Icd-9 Coding Quiz:
How Well Do You Know the New ICD-9 Codes?
New codes take effect on Oct. 1--Find out if you're ready.October 1 is just around the cor... Read more
Clip and Save:
Tackle HPV Vaccine Payment Woes With A Solid Financial Responsibility Form
The more specific your form is, the better your payment odds.If you aren't having your ped... Read more
News You Can Use:
Medicaid Will Implement RAC Audits Jan. 1, CMS Says
Recent delays have given you more time to prepare. You've benefited from several delays in... Read more
Make Sure Your Billing Service Isn't Putting You at A Compliance Risk
This billing service overcharged Medicaid by millions for physicians' charges.If your pedi... Read more
Reader Question:
New Problems May Not Mean New Patient Visit Codes
Question:  Our office saw a patient six months ago for a certain condition, and sent ... Read more
Reader Question:
Don't Let Wheezing Dx Trip You Up
Question: Sometimes our physician suggests diagnosis 519.11 for wheezing, but sometimes he... Read more
Reader Question:
Modifier 55 Won't Apply to Suture Removal
Question: An 11-year-old established patient went to the emergency room in another state o... Read more
You Be the Coder:
Nail Down Pilonidal Cyst Details
Question: Can you help me with CPT® code assignment for this procedure? The cha... Read more
Preventive Services:
Separately Report These 5 Services When Performed With Well Visits
Don't write off payment for injections, screenings, and other services during preven... Read more
Know How to Question Your Payer if It Denies Procedures Performed With Preventive Visits
File a well-written appeal to collect your due. Even if you follow our advice to the t... Read more
Coding Quiz:
Take the 99211 Challenge
Hint: You can't automatically tack 99211 on to every service just because the nurse was pr... Read more
Reader Question:
Insurers Require Medical Necessity for Hospital Visits
Question: A newborn has been in the hospital for two weeks and our pediatricians have be... Read more
Reader Question:
Scratch J0570 From Superbills
Question: We've been getting denials when we report codes J7610 (Albuterol, inhalation sol... Read more
Reader Question:
'Transition Planning' Payment Could be Tough
Question: Our office wants to start coding for transition planning and scoring, which invo... Read more
Reader Question:
Not All AAP-Recommended Visits Are Payable All the Time
Question: Is it acceptable to offer (and charge for) 30-month visits? If so, how do we han... Read more
You Be the Coder:
Know How to Code 'Just in Case' Med Requests
Question: I have a teen patient who is going abroad with his family and the patient's moth... Read more
Diabetes Management:
Diabetes Coding Can Be As Simple As 1-2-3
Hint: Report only diabetic complications related to current episode of care.Veteran coders... Read more
E/M Coding:
Choose the Correct Physical Exam Level Every Time With These 4 FAQs
Tip: Use Caution When Keeping E/M Templates at Hand.Whether you have significant coding ex... Read more
Use This Quick Chart to Find the Right Exam Level Every Time
With two sets of guidelines -- 1995 and 1997 -- for assigning a physical examina... Read more
Diagnosis Coding:
Use E Codes to Establish Medical Necessity, Fully Document Accidents and Injuries
Tip: Never list E codes as primary diagnoses. Accidents do happen--and when it comes t... Read more
Reader Question:
Know the Ropes for Lead Testing
Question: How often can we bill for lead screenings? And which diagnosis code should we re... Read more
Reader Question:
Classify Allergies Correctly During Patient's Evaluation
Question: The pediatrician documented NKDA (no known drugallergies) as part of a patient's... Read more
Reader Question:
Be Diligent With Medicaid Forms
Question: We are not listed with the Medicaid system in our state as a participating Medic... Read more
You Be the Coder:
Payers May Balk at V20.2 for Vaccines
Question: One of our payers suddenly began questioning claims that we submit which have V2... Read more
Diagnosis Coding:
Check Out New Anaphylactic Reaction Diagnosis Codes
Many new codes abound in final update to proposed ICD-9-CM code set.If you've felt that yo... Read more
Correct Coding Initiative:
CCI Went Easy on Pediatric Bundles This Time Around
Other than fine need aspiration coding, you're in the clear in terms of CCI edits.If new e... Read more
Modifier Quiz:
Think You Know Your Modifier Rules Like A Pro? Check These FAQs to Find Out
Avoiding modifiers because you don't know the rules could cause you to leave cash on the t... Read more
Reader Question:
Know When to Bill Secondary Payer
Question: We have many patients with secondary insurance, some of which have deductibles o... Read more
Reader Question:
Fill in the 'x' When Deciphering E/M Codes
Question: In a recent issue of Pediatric Coding Alert, you advised coders to report "an ou... Read more
Reader Question:
Use 'V' Codes When Testing for Previous Vaccinations
Question: We performed a Hep B Surface Ab and a Varicella-Zoster Ab, IgG on a foreign-born... Read more
Reader Question:
Get Payer Advice in Writing Regarding Employee Copays
Question: My physicians are looking at giving employees a courtesy for their co-pays but w... Read more
Reader Question:
Check With Payer Regarding Medicare-Specific Codes for Diabetes Training
Question: We have a pediatric endocrinologist on staff, and his nurse performs diabetes ed... Read more
You Be the Coder:
Consider Whether Modifier 25 Applies
Question: At a 13-year-old girl's preventive medicine service, a pediatrician learns that ... Read more
Meet-and-greet Coding:
Consider These 4 Options When Coding 'Get Acquainted' Visits
Time is money, but it can also be good PR for your practice.Do you ever meet with parents ... Read more
Answer the $56 Question -- Are You Downcoding Your E/M Visits?
You're not only losing revenue -- you're also coding improperly.National insurer data... Read more
E/M Components:
Stop Forfeiting Level Four and Five E/Ms With 3 PMFSH Tips
Make the pediatrician's job easier by letting the patient or nurse document the past, fami... Read more
Know the Aspects of PFSH
Per CPT®, past medical, family and/or social history is divided into three subsectio... Read more
Reader Question:
Can You Collect Extra for Emergency Walk-Ins?
Question: We recently hired a new pediatrician who is questioning whether we can bill any ... Read more
Reader Question:
96372 Applies If Patient Brings Own Meds
Question: One of our pediatric patients reports for an Enbrel shot weekly. The parents ref... Read more
Reader Question:
99464 Isn't Billable for Missed Deliveries
Question: Prior to delivery, an obstetrician asked that one of our pediatricians be presen... Read more
You Be the Coder:
Know the Ropes for Problem Discovered During Well-Visit
Question: We have a Medicaid patient that came in for a tenyear- old physical and was foun... Read more
Newborn Care Coding:
Know When to Adjust Newborn Care Codes
'Normal' newborn codes may not always be the most appropriate for your patients.... Read more
Summer Coding Quiz:
Do You Know These Summertime Coding Rules? Take This Quick Quiz to Test Yourself
Hint: Have the appropriate 'Q' modifier ready for substitute physicians who fill in when y... Read more
Summer Coding Quiz Answers:
How Did You Fare When Checking Your Summer Coding Skills? Check Out the Answers Below
Tally your score with the following three solutions.Determine whether you're ready for sum... Read more
Clip And Save:
Use This Quick Go-To Guide for Coding and Billing Camp and Sport Exams
From ICD-9 coding to your forms policy, we've got you covered.Summer camp season is right ... Read more
Reader Questions:
Coding Negative Strep Test Forces You to Rely on Symptoms
Question:Which diagnosis codes should we report for a strep test that comes out negative i... Read more
Reader Questions:
Don't Report 90460-90461 Without Counseling
Question:If we report the new 90460 and 90461 vaccine codes, must the physician perform th... Read more
Reader Questions:
You Won't Collect for Code 1005F
Question:One of our pediatricians monitors our asthma patients with the Childhood Asthma C... Read more
Reader Questions:
Don't Report Discharge Without Face-to-Face
Question:Often, I will tell a new mom that she can take her baby home from the hospital th... Read more
You Be the Coder:
95115, 95117: Who Should Injection Serum?
Question: A parent brings allergy serum to our office. The patient comes in once every two... Read more
E/M Coding:
These 3 FAQs Will Ensure You're Reporting Time-Based E/M Services Properly
One hour E/M visit? You don't warrant a prolonged service code yet, experts say.If coding ... Read more
CCI 17.1:
No Modifier Will Allow You to Report 99211 With Vaccine Code 90460
Plus: One edit will face 'swapped columns'You may just be getting used to the new codes in... Read more
Lyme Disease:
Determine Whether Your Lyme Disease Diagnosis Code Assignment Makes the Grade
Injury code hinges on your venomous, nonvenomous savvy -- and more.Think a tick is venomou... Read more
Icd -10 Preparation:
Get to Know How Lyme Disease Coding Will Change After Oct. 1, 2013
Tip: Lyme disease series expands out to five codes under ICD-10.With Lyme disease coding b... Read more
E/M Coding:
Your EHR is Not 'Audit-Proof,' Experts Say
The responsibility is on your practice--and not the software--to ensure that you're report... Read more
Reader Questions:
It's Okay to Bill Several Immunization Administration Codes Together
Question: After reading your informative articles on the vaccine coding for 2011, I have... Read more
Reader Questions:
Don't Bill for Services You Don't Perform
Question: Our state requires that a newborn metabolic screen must be performed on all newb... Read more
You Be the Coder:
Is Modifier 59 Required?
Question: I read that Medicaid will pay for 94664 (Demonstration and/or evaluation of pa... Read more
Time-based Coding:
CPT Allows You to Select Code Based on 'Closest Typical Time' When Counseling Dominates Visit
Remember to always document visit times when coding based on the clock.Picture this: A ped... Read more
87804: Follow These Tips to Avoid Denials for Second-Strain Flu Testing Claims
When determining whether a patient has both A and B strains, look to your insurer regardin... Read more
Attention Deficit Disorder:
Report Sign/Symptoms for Patients Who Exhibit ADD Traits But Don't Have Definitive Dx
Key: Avoid 'labeling' a patient with ADD or ADHD if you haven't yet reached a diagnosis.Pu... Read more
Your ADD/ADHD Coding Will Change Dramatically Under ICD-10
Tip: Code range for these conditions will expand from just two codes in ICD-9 to five code... Read more
RAC 'Bounty Hunters' Turning Their Sights on Medicaid Claims
Fortunately, recent delays give you more time to plan for these audits.Because pediatric p... Read more
Reader Questions:
Consider Other Sources When CCI Doesn't Provide Info
Question:Thank you for your new series on Correct Coding Initiative (CCI) edits. Sometimes... Read more
Reader Questions:
Get the Lowdown on 94011-94013
Question:Can you clarify the three new codes (94011-94013) that were added last year for i... Read more
Reader Questions:
Look to 99211 for TB Test Check
Question:We were told that we could bill Medicaid when we read TB test results. Is this tr... Read more
Reader Questions:
Friction Burns Still Count As 'Burns'
Question:A three-year-old child was brought in with multiple friction burns from a treadmi... Read more
You Be the Coder:
Is 'Personal History' Different Than 'Family History?'
Question: My understanding has been that I cannot bill for "family history of" a condition... Read more
Vaccine Coding:
90460-90461: Payers Vary Widely on How to Report New Vaccine Codes
Don't hesitate to check with your payer before submitting your immunization claims.Just a ... Read more
Practice Perspective:
Get to Know Whether to Hold Vaccine Claims Or Submit Them Now
This practice confirmed whether its payers were ready to accept vaccine claims.If your ins... Read more
New Z Diagnosis Codes Will Replace Routine Health Check Codes in 2013
Here's what you should look for in your physician's documentation.When ICD-9 becomes ICD-1... Read more
Clip And Save:
Use This Simple Tool to Ensure You Cover Every System Possible
Confirming that your doctor's documentation captures every system he reviewed guarantees y... Read more
E/m Coding:
99214: Know Whether You Qualify for Higher-Level Codes
Without documentation of each system, prepare to assign a lower code.Medical practices tha... Read more
Reader Questions:
Solve Unknown Skin Rash Dx Issues With NOS Code
Question: A patient recently reported to our office with a rash on his chest and abdominal... Read more
You Be the Coder:
Elucidate Infection Type for Tissue Infection Dx
Question: Our pediatrician treated a soft-tissue infection on a patient's finger. Which di... Read more
Correct Coding Initiative:
CCI Takes Aim at New Vaccine Administration Codes
But you'll find good news about coding debridement.In our December 2010 Pediatric Coding A... Read more
Sports Physicals:
These 5 Strategies Make Coding Sports Physicals A Home Run
Parents can choose covered annual or self-pay exam.Your pediatric practice probably gets c... Read more
Perform A Successful Self-Audit With These Quick Tips
Use all of the resources at your fingertips, including audit score sheets.In last month's ... Read more
Replace 2011 Vaccine Chart With This One
Plus: Check state laws to determine who can administer vaccinations.With new codes come ne... Read more
Reader Questions:
Code Splinting Only if No Restorative Treatment Is Administered
Question: A 3-year-old child presented to our office with a history of falling off a chair... Read more
Reader Questions:
Differentiate Pediatrician's Role in ECG
Question: After obtaining a patient and family health history and doing a physical exam fo... Read more
You Be the Coder:
Is Modifier 51 A 'Helping' Modifier?
Question: When the same physician gives multiple vaccines at the same encounter, should I ... Read more