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Pediatric Coding Alert

E/M Coding:
No 'Standard' Code Applies to Pediatric E/M Services
Select the appropriate code based on the documentation--not the specialty or diagnosis. ... Read more
CPT 2013:
Prep Now for Critical Care, Sleep Study Code Changes That Take Effect Jan. 1
New edition of CPT will impact the way you report these pediatric services.If coding criti... Read more
OIG to Scrutinize Pediatric Antipsychotic Prescriptions in 2013
Plus: Medicaid audits will determine whether special need school services were medically n... Read more
New 'J' Code Will Replace 034.0 for Strep Throat Dx Under ICD-10
Fortunately, however, coding choices for this condition won't expand dramatically.Your ped... Read more
Reader Question:
Look to Modifier 25 for Nebulizer, E/M Combo
Question: I just received a denial after reporting 99213 with 94664 (Demonstration and/or ... Read more
Reader Question:
Consider Options for New 'Flu Shot Only' Patients
Question: We are trying to decide how to handle new patients who want to come in just fo... Read more
Reader Question:
'Bullying' Codes Take Back Seat to Main Symptoms
Question: Which diagnosis code should we report when bullying is a factor? We had a 13-yea... Read more
Reader Question:
Know Your 'E' Codes for Anaphylaxis Causes
Question: What do you recommend as the most specific E code for anaphylaxis reaction to pe... Read more
Reader Question:
Get Specific With Pneumonia Dx
Question: Which ICD-9 code should we use for pneumonitis? I had been using "486" but one o... Read more
You Be the Coder:
Avoid Assumptions With Headache Dx
Question: A co-worker says we can submit "headache" and "migraine" on the same claim, but ... Read more
CPT® 2013:
New Pediatric Transport Codes Will Help Ease Your Coding Stress
Plus: Changes throughout CPT's E/M section bring non-physicians to the forefront. ... Read more
E/M Coding:
Answer These 3 Quick Test Questions to Evaluate Your E/M Knowledge
Test your skills with these questions to see where you should focus your E/M education.Eva... Read more
Quick Quiz Answers:
Evaluate Your Own E/M Coding Skills With 3 Test Answers
See where you should focus your E/M education.Answer 1: Yes. Based on E/M guidelines, if a... Read more
Acute Laryngitis Remains Easy Coding With J04.0 in ICD-10
Look how many conditions the code will represent when ICD-10 goes into effect. Diagnos... Read more
Reader Question:
'Case Management' Can Be Coded Various Ways
Question: Does CPT® include any procedure codes for case management, phone calls to ... Read more
Reader Question:
Avoid Assigning 'Probable' Dx
Question: I've read in previous issues of Pediatric Coding Alert that if the treating phys... Read more
Reader Question:
CCI Bundles Cerumen Removal With Injection
Question: Has injection administration (96372) always been bundled with 69210?  I jus... Read more
Reader Question:
Only Bill E/M If One Was Provided
Question: This is the first year we are considering providing FluMist without a physician ... Read more
Reader Question:
Ask Physicians How to Count 'Supple Neck'
Question: When my pediatrician writes "Neck is supple," should I count the phrase as part ... Read more
Reader Question:
Take This 'No Man's Land' Coding Advice
Question: A mother brought her daughter for a well child check-up, although she didn't hav... Read more
You Be the Coder:
Unnecessary Lab Test Probably Won't Be Payable
Question: We have a patient who did not have a urinalysis done at his previous well visi... Read more
CPT® 2013:
Discover These Vaccine Coding Changes That Will Impact Your Pediatric Practice in 2013
If your payer is denying 90718, you should appeal through the end of the year.Your CPT... Read more
CPT® 2013 Will Include New Care Coordination Codes
New CPT® manual will include 186 new codes and 119 deletions, AMA reveals.Although t... Read more
CMS Confirms Oct. 1, 2014 As New ICD-10 Implementation Date
One year delay is expected to allow practices more time to prepare.It's been nearly eight ... Read more
Bronchitis Codes Will Hinge on Cause Under ICD-10
Heads up: Single ICD-9 code transforms to ten codes in ICD-10.You'll face big changes in r... Read more
E/M Coding:
Discover Medical Decision-Making Made Easier With These Tips
Hint: The "if this, then that" notes are key when determining level of risk.Selecting the ... Read more
Reader Question:
Bundle Dressing Change Into E/M
Question: Our patient had an abscess on her leg that was treated several days ago. Today, ... Read more
Reader Question:
Differentiate Vaccine From Other Injections
Question: A 16-year-old patient presented for a Depo-Provera injection. She brought the va... Read more
Reader Question:
'Counseling' Is Key Word for Vaccines
Question: Our physician circled codes for administering a vaccine (90715) and its administ... Read more
You Be the Coder:
One Office Visit Translates Into One E/M Code
Question: A patient presented at our office with a bruise. The pediatrician examined the p... Read more
AFFORDABLE CARE ACT - 3 Facts Show You What the Government's Healthcare Ruling Means for Your Pediatric Practice
Know your state's Medicaid regs front and back because you may see an increased Medicaid p... Read more
Summer Coding:
Take the Pain Out of Coding Sunburns, Bee Stings, and Other Summer Visits With These Quick Tips
Know how swimmers' ear code will change under ICD-10. Summer weather means swimming, camp... Read more
Affordable Care Act:
3 Facts Show You What the Government's Healthcare Ruling Means for Your Pediatric Practice
Know your state's Medicaid regs front and back because you may see an increased Medicaid ... Read more
Pediatric Payment:
Proposed 2013 Fee Schedule Offers Five Percent Raise for Pediatricians
Plus: Additional payments for hospital transitions could boost your income if finalized.... Read more
Reader Question:
Avoid Assigning 'V' Codes You Can't Support
Question: We just starting billing code 99420 (Administration and interpretation of healt... Read more
Reader Question:
Parking Lot POS Should Translate to Office
Question: How do I bill a service that took place in our parking lot? The mother of the p... Read more
Reader Question:
Modifier 25 Supports Your Nursemaid's Elbow, E/M Claims
Question: Our pediatrician treated a 3-year-old patient for nursemaid's elbow. What proce... Read more
Reader Question:
Find Out What Supports 99441-99443
Question: A parent leaves a message seven days after the previous related E/M visit and w... Read more
Reader Question:
Know How to Handle Deductible Balance
Question: Our patient has two insurers--Payer A is the primary and Payer B is the seconda... Read more
You Be the Coder:
Check State Law When Patient Requests Confidentiality
Question: How should we label a chart when an adolescent confides in the pediatrician abo... Read more
Bust These 5 Myths to Ensure You Hang on to Your Immunization Income
Keep your vaccine money flowing with these easy-to-implement tips. Vaccine payments mak... Read more
Vaccine Coding:
Bust These 5 Myths to Ensure You Hang on to Your Immunization Income
Keep your vaccine money flowing with these easy-to-implement tips.Vaccine payments make up... Read more
Turn to 'H61' Series for Impacted Cerumen Coding Under ICD-10
Plus: AMA 'Evaluating ICD-11' As ICD-9 AlternativeCurrently, you have one way to report im... Read more
Considering Waiving Copays? Check These Tips First
Proving financial hardship will be the key to confirming eligibility.In seminar after semi... Read more
Reader Question:
Document Errors in Records
Question: The physician saw several patients on the same day with sore throat symptoms. Hi... Read more
Reader Question:
'Consult' Can Be Semantics
Question: Our pediatrician wrote in the documentation, "Performed consultation with well c... Read more
You Be the Coder:
Insurers Won't Pay for These Supplies
Question: Can our pediatrician's office bill a syringe code with a vaccine administration ... Read more
Concussion Management:
3 Tips Help You Code Head Injuries
Learn what options you have for treating cognitive deficits.Scanning your ICD-9 coding man... Read more
Practices Appear to Be Split on Advantages to ICD-10 Delay
The AMA, however, has requested delay extended further, through 2015.Whether you submitted... Read more
Still Confused About ICD-10's Benefits? Read This
The learning curve may seem steep, but you'll reap the benefits of ICD-10If your only expo... Read more
Your Top 3 Hospital E/M Billing Questions Answered
Can you navigate the intricacies of inpatient E/M services? Check these expert solutions... Read more
Reader Question:
Complaint May Not Equal Final Diagnosis
Question: I have a new patient that is four days old presenting to our office with a chi... Read more
Reader Question:
You Can't Read Between the Lines to Select E/M Level
Question: I saw a 16 year-old patient with an established diagnosis of syncope that our ph... Read more
Reader Question:
94664 Is the Key to Asthma Education
Question: Which code should we report when we perform asthma education to asthmatic patien... Read more
You Be the Coder:
Code Correctly, Regardless of Payment
Question: We are receiving denials for CPT code J7610. Should we be billing a different co... Read more
2013 CPT Coding:
CPT May Provide Massive Changes to E/M Notes Next Year
AMA offers preliminary peek at proposed 2013 codes.This year isn't even halfway over, but ... Read more
CMS Proposes 2014 As New ICD-10 Compliance Date
One-year delay may help practices be ready before hammer comes down.Pediatric practices ha... Read more
Lab Testing:
Consider Urinalysis Method Before Selecting From 81000-81003 Series
Be sure you have the right code, whether you test for 1 element or all 10.Urinalysis may s... Read more
Don't Click That Link! Medical Practices Particularly Vulnerable to Online Security Threats, Experts Say
Get to know this and other privacy risks so your practice remains compliant.As a pediatric... Read more
Reader Question:
Check Consult Rules for NP's Lactation Visit
Question: We have a nurse practitioner (NP) who specializes in lactation consulting. Pedia... Read more
Reader Question:
Avoid 'Phone' Codes for Visit Follow-Ups
Question: Our pediatrician saw two patients on Friday who subsequently had increased bilir... Read more
Reader Question:
Delve Into Dx Choices When Monitoring Ritalin Use
Question: For an electrocardiogram (ECG) (93000-93010, Electrocardiogram, routine ECG with... Read more
You Be the Coder:
Most Insurers Consider Concussion Impact Tests 'Screening'
Question: We recently started performing baseline impact testing for concussions. Which di... Read more
Documentation of Time Is Critical When It Comes to Time-Based E/M Coding
Remember to summarize what was discussed during counseling.Pediatricians may spend more ti... Read more
Master These 4 Pediatric-Specific Modifier 25 Issues
Hint: When billing both well and sick child visit, put modifier 25 on the sick visit cod... Read more
Considering Going Out of Network? Follow These 3 Tips to Pave the Road to Success
Be honest with your patients to ensure a smooth transition.More and more providers are que... Read more
Reader Question:
Neonatologist Code Depends on Infant Location
Question: We have a "Neonatal Rapid Response Team" (NRRT) in which a respiratory therapist... Read more
Reader Question:
Check Age Requirements for 778.6
Question: We billed ICD-9 778.6 for a 6 year-old male patient, but the insurer is stating ... Read more
Reader Question:
90862 Helps for ADHD Patients
Question: I read your article, "Capture All Your Work When Treating Kids Who Have S... Read more
Reader Question:
Know When 'Incident To' Rules Apply
Question: I have a case where one physician (physician A) in my practice covered an establ... Read more
Reader Question:
Generic vs. Brand Name Won't Change Your J3301 Billing
Question: My doctor is using Kenalog 40 (NDC 0003029328) from Bristol Myers Squibb. He s... Read more
You Be the Coder:
Payer May Allow You to Destroy Depression Questionnaire
Payer May Allow You to Destroy Depression Questionnaire Question: In our pediatric practic... Read more
Billing Errors:
One Medicaid Payer Reveals Its Top 5 Errors -- Know How You Can Avoid Making the Same Mistakes
Coding errors once again top the list of the most common mistake. Did you catch a misc... Read more
Repeat Procedures:
Differentiate Your Distinct and Repeat Procedures With These 6 Quick Tips
Use modifiers 59, 76 and 77, and 91 without jeopardizing your pay. When you consider r... Read more
Consider These Epistaxis Changes Under ICD-10
Plus: HHS confirms that ICD-10 date will be pushed back. Although nosebleeds can be co... Read more
Clip And Save:
Know These 'Repeat Procedure' Modifiers -- And When You Should Use Them
Keeping your repeat modifiers straight can be confusing--look to this simple chart to help... Read more
News You Can Use:
One Payer Formally Confirms Male HPV Vaccine Payment
United Healthcare now covers these vaccinations for males and females ages nine through 26... Read more
Reader Question:
Even 'Quick Assessment' Creates Established Patient Status
Question: Our pediatrician saw a newborn as a quick assessment within a few days of birt... Read more
You Be the Coder:
Contraception Diagnosis Code Depends on Specifics
Question: One of our practitioners discussed sexual activity and contraception with an ado... Read more
Revenue Booster:
Capture All Your Work When Treating Kids Who Have Special Healthcare Needs
Diabetes, ADD, and asthma aren't always an E/M-only visit. Collect for your other services... Read more
Consider These Big Changes for Diabetes Coding Coming Next Year
Under ICD-10, you'll say goodbye to the '250.x' series.As most pediatric coders are aware,... Read more
Pediatric Payment:
99460: Look for a 61 Percent Boost to Your Initial Newborn Care Services
Plus: Office-based well child visits also get a raise. You may not treat Medicare pati... Read more
Clip And Save:
Reveal Your Pediatric Cash Flow in 5 Simple Steps
Chart your A/R and other billing variables to ensure you don't leave money in your insurer... Read more
Reader Question:
Don't Consider Reporting 99211 With 96372
Question: If a patient pays for her medicine and goes to our nurse to give the injection, ... Read more
Reader Question:
CPT Doesn't Include '911' Code
Question: One of our patients presented for a sick visit but was so ill that the pediatric... Read more
Reader Question:
Look to Modifier 25 for Cath with E/M
Question: A 3-month-old patient presented to our practice for a sick visit. Her mother sai... Read more
You Be the Coder:
Insurers May Require You to Bundle Same-Day E/M Services Together
Question: Can we bill two office visits on the same day? We reported 99214 twice for the s... Read more
96110: Use This Tool to Fight Medicaid Denials for Developmental Screening
Although CMS originally withheld RVUs for this code, you'll now find an update.If your Med... Read more
Correct Coding Initiative:
Reporting Subsequent Hospital Care With Neonatal Intensive and Critical Care Codes? Not Anymore, Thanks to CCI 18.0
Plus: New edition of bundling edits targets 2012 CPT codes. You may just be digging in... Read more
E/M Coding:
99058: 'Walk-in' Patients Alone Won't Qualify You for This Emergency Code
Highlight the phrase "in addition to basic service."Pediatricians don't always see patient... Read more
CMS Outlines New ICD-10 Codes for 2012
Consider these changes that have already been instituted before the code set even takes ... Read more
Reader Question:
Conversion Factor Increase Will Help Pediatric Practices Through Feb. 29
Question: Two of our insurers follow the Medicare fee schedule in assigning fees, and we r... Read more
Reader Question:
Elucidate Recording of 'None' for Family History
Question: Our physician often records the word "none" under the "family history" section o... Read more
Reader Question:
'Prevnar-13' Does Not Contain 13 Components
Question: What is the proper way to bill for Prevnar-13? Our coding/billing staff is confu... Read more
Reader Question:
Consider These Diabetes Education Options
Question: A pediatrician and physician assistant are educating some parents on diabetes, e... Read more
Reader Question:
Don't Separately Code Pain Reliever Administration
Question: Is there a code that I can use for the administration of Tylenol or Motrin? Th... Read more
Reader Question:
E/M Code Assignment Is Unrelated to Established Problem
Question: We recently finished our first internal audit and found a potential issue: One o... Read more
You Be the Coder:
Know the Ropes for Reporting Sick Evaluation During Well Visit
Question: When parents present with infants for regular health checkups at two, four, and ... Read more
CPT® 2012:
Pediatric Hospital Rounds Will Be Easier to Code, Thanks to CPT® Clarifications
Differentiate the four common types of pediatric hospital visits and you'll be on the road... Read more
Scroll to 'P59.x' Section When Coding Jaundice After ICD-10 Takes Effect
Note: Medicaid contractors are working to meet ICD-10 deadline.If you're like most pediatr... Read more
To Err Is Human--But You Can Correct Medical Records--If You Follow These 5 Tips
You can make medical records accurate even after the visit, as long as the practitioner he... Read more
Documentation Red Flags:
Know When A Record Clarification Hurts Instead of Helps
If you correct or add to every medical record that gets reviewed, you may come to regret i... Read more
Reader Question:
Turn to 90460 for FluMist
Question: Our billing department has been reporting 90474 when the pediatrician administer... Read more
Reader Question:
Consider V79.3 for Developmental Screening
Question: Our insurer has been denying all of our claims when we report 96110 with V20.2. ... Read more
Reader Question:
Know How Many 'Vitals' Total 1 Exam Bullet
Question: Can you please explain how taking the vital signs contributes to determining the... Read more
Reader Question:
Many Insurers Still Accept Consult Codes
Question: An established patient who was about to undergo a tonsillectomy presented to our... Read more
You Be the Coder:
Determine Whether 99058 is Justified
Question: A Medicaid patient came to the office on an emergent basis with several lacerati... Read more