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Pediatric Coding Alert

Don't Shy Away From Billing High-Level Codes When Warranted
See what this practice did right, and what it did wrong. If you see a patient who has ... Read more
J45 Shifts Focus to Severity for Asthma Reporting
Hint: Identify symptoms and medication use for accurate reporting. Asthma is a common ... Read more
5 Essential Tips Help You Collect for Inhaler Education
Inhaler demo could pay you $19 — if you know how to navigate the rules. When you... Read more
Reader Question:
Is Counseling Included in Preventive Service?
Question: When we billed CPT® codes 99395-25 (Periodic comprehensive preventive medi... Read more
Reader Question:
Vaccines Don't Automatically Warrant 99211
Question: The coder at another practice recently told me that 99211 is allowed with a we... Read more
Reader Question:
Know Your 99051 Limitations
Question: We are not usually open in the evenings or on the weekends, but we have decide... Read more
Reader Question:
Consider How to Collect for 30 Month Visits
Question: We have a new pediatrician who has scheduled several 30-month visits. How can ... Read more
You Be the Coder:
Develop Your Own Policy for Billing Meet-and-Greets
Question: We often have parents who come in wanting to get to know the pediatrician befo... Read more
CPT® 2014:
Prep Now for New Consultation, Speech Evaluation Codes
CPT® 2014 also offers several new vaccine codes. Just like an early holiday presen... Read more
The Problem in This E/M Note Cost This Practice Over $65
Know what you can’t miss when billing new patient visits Most pediatric practice... Read more
Look to F50 Series for Eating Disorder Diagnoses
Hint: Distinguish from binge eating or purging type to nail the ICD-10 diagnosis. When... Read more
Reader Question:
Know How to Email Without Violating HIPAA
Question: I sometimes e-mail patient records to consultants for help on how to bill... Read more
Reader Question:
Differentiate Depression From Anxiety
Question: What is the appropriate way to code a claim when the physician calls out ... Read more
Reader Question:
2 Specialists May Generate Two Separate Visits
Question: Can a patient be seen by two different providers in a billing group on the sam... Read more
Reader Question:
Create A Policy for WIC Visits
Question: When the pediatrician sees a patient on the WIC (Women Infant and Childre... Read more
Reader Question:
Ensure That Your Appeals Have A Chance at Success
Question: When we know that the carrier has made a mistake in denying one of our cl... Read more
You Be the Coder:
Nail Down Depression Screening Code
Question: My doctors have been using 96110 for their developmental screenings as well as... Read more
Breaking News:
New Edition of CPT Debuts 'Interprofessional Telephone/Internet' E/M Codes
Plus: You’ll also find changes to cerumen removal code. When some payers stopped... Read more
E/M Coding:
Can You Spot the Problem in This E/M Note?
Review this documentation and determine how you’d code it before you read the solu... Read more
Well Patient Coding:
'V' Codes Can Be Your Friends for Non-Injured Patients
Remember that V20.2 isn’t your only well-visit option. You see it at least once ... Read more
Know How to Code Abuse/Neglect Checks
Often, ‘V’ codes will be required for such visits. Unfortunately, every pe... Read more
Memorize R10.83 for Your 2014 Colic Coding Choice
Under ICD-10, you’ll say goodbye to 789.7. Pediatric practices are absolutely fa... Read more
Bust 5 Common Compliance Myths With These Quick Tips
True or false? Being unaware of accidental overpayments can’t invoke false claims ... Read more
Reader Question:
Include BMI Calculation in E/M
Question: We have been calculating our patients’ body mass index (BMI) when we per... Read more
Reader Question:
Avoid Consult for Parent Meeting
Question: A parent came into our office without the patient to speak with one of our ped... Read more
You Be the Coder:
Know the Consult Rules
Question: A patient presented for an ADHD evaluation. Can we report consult code 99... Read more
Seasonal Coding:
Your Top 3 Autumn Coding Questions Answered
Is loss of consciousness required for a concussion? Find out here. As your patients he... Read more
E/M Coding:
Can You Spot the Problem in This E/M Note?
Review this documentation and determine how you’d code it before you read the solu... Read more
Coding Head Injuries Will Lead to Multiple Choices Next Year
Provide precise documentation and narrow it down to the right code. When your pediatri... Read more
Work With EMR Vendor on Templates
When you’re new to electronic medical records (EMRs), it may be tempting to simply... Read more
Reader Question:
Look to HCPCS for Oral Medication
Question: Our pediatrician sometimes administers an oral dose of an antibiotic or predni... Read more
Reader Question:
Local Rules Trump National Guidance
Question: I know you often recommend 96110 for the MCHAT administration, but we use 9942... Read more
You Be the Coder:
Check Contract, Then Bill Patient
Question: We would like to know when an insurance company denies a procedure and states ... Read more
E/M Coding:
Can You Spot the Problem in This E/M Note?
Review this documentation and determine how you’d code it before you read the solu... Read more
Leave the HPI Details to the Provider, But Leverage Nurse Help When You Can
Identify which portions of the record ancillary staff can capture. Your pediatrician&... Read more
Look to 'A' Codes to Report Rotavirus Under ICD-10
Your coding options next October will fortunately be transitioned on a one-to-one basis.... Read more
Handling Codes:
Know When 99000 Applies Outside of Specimen Shipping
In some cases, you can report 99000 even if you aren’t facing a transport charge. ... Read more
Reader Question:
Blisters May Not Be Listed As 'Ischemic'
Question: I’m coding a case of treatment for an ischemic blister of the right grea... Read more
Reader Question:
Some Insurers Have Age Restrictions
Question: I have had two patients who have United Healthcare call to say that UHC has to... Read more
Reader Question:
It's Okay to Shuffle Diagnoses
Question: Our pediatrician documented obesity as a contributing factor in a patient&rsqu... Read more
Reader Question:
Know What Supports Billing 99441-99443 Calls
Question: A patient called during the weekend and left a message for our pediatrician as... Read more
Reader Question:
How Do You Report 'Calming Shot?'
Question: One of our patients was on his way to have an x-ray at the hospital. His mothe... Read more
You Be the Coder:
Non-Problem Counseling May Not Be Payable
Question: A parent of a large family came into the office with two sick children who wer... Read more
E/M Coding:
Spot the 3 Main Problems With This Pediatric E/M Note
Find out what this practice did wrong so you can avoid making these mistakes. You&rsq... Read more
Seasonal Coding:
Your Top 5 Summertime Coding Questions Answered
Look to ‘V’ codes for non-injured patients. Summer is upon us, which means... Read more
Some Auto, Worker's Comp Insurers May Opt out of ICD-10, CMS Says
But Medicaid plans will not give you an extension past Oct. 1, 2014, the agency stresses... Read more
Reader Question:
Consult or Initial Hospital Care? Choose One
Question: Our neonatologist was called to a consult (99251) and then determined the baby... Read more
Reader Question:
Know What Counts for MCHAT Documentation
Question: Our office has the parent complete the MCHAT, which we then scan into the pati... Read more
Reader Question:
Medical Necessity Reigns for Non-Mandated Dental Exam
Question: Our state’s Medicaid program is requiring pediatricians to perform a den... Read more
You Be the Coder:
Code When the Neonatologist Is Called But Not Needed
Question: Our neonatologist was called for a mandatory emergently problem with newborn i... Read more
Know How to Code When There's A Doctor in the (Patient's) House
99341-99350 can be your friend if you make house calls.   The image of a physic... Read more
4 Tips Lead You to Supply Billing Success
Hint: 99070 is not a one-size-fits-all materials code. When it comes to billing for su... Read more
Office Visits:
Boost Your E/M Bottom Line With These Quick Tips
Chief complaint shouldn’t be ‘follow-up.’ E/M coding might be part o... Read more
Go Deeper When Pediatrician Documents 'Unspecified'
Good news: Code 079.99 has a one-to-one relationship. Pediatricians treat viral infect... Read more
Reader Question:
Don't Forget Dx for Office Visits
Question: A cystic fibrosis patient and her mother met with our pediatrician to discuss ... Read more
Reader Question:
Bundle E/M Visits for the Same Day
Question: Our NP (who specializes in diabetes education) is working with our pediatricia... Read more
Reader Question:
Are There Alternatives to Modifier 25?
Question: I’m trying to get away from using modifier 25. Is there a requirement sa... Read more
You Be the Coder:
Check Weight for Newborn Intensive Care Codes
Question: Can we use 99479 for a newborn (34 weeks estimated gestational age) that has a... Read more
Medicaid Pay Boosts Are Available, But You Must Self-Attest
Don’t worry if you haven’t seen pay raises yet—they’ll be retroa... Read more
Sequestration Cuts Won't Impact Medicaid, CHIP
If you’ve seen the news over the past few weeks, you know that the government had ... Read more
Mid-Level Providers:
We Answer Your 5 Most Pressing Incident-to Questions
Hospital-based incident to? Not so fast. Many pediatric practices have mid-level provi... Read more
Prep Now for Next Year's Croup Coding Transition
Be ready to signify the cause of the croup under ICD-10. Coding for children with crou... Read more
Reader Question:
Check Options for Visit With Parent
Question: The parent of one of our established patients is coming in for a consultation.... Read more
Reader Question:
No Codes Address 'Health Coach'
Question: I am looking for CPT® or HCPCS codes for health coach services that would ... Read more
Reader Question:
Office Can't Bill Bandage Supply
Question: A patient reports with a swollen right ring finger that she injured while catc... Read more
Reader Question:
Confirm Insurance in Lieu of Card
Question: How should I handle a patient who has new coverage but has not received an ins... Read more
Reader Question:
Saturday Hours Won't Rely on Diagnosis
Question: Our office is open on Saturdays. What ICD-9 codes would the claim require to u... Read more
Reader Question:
Extra Questions May Not Boost ROS
Question: Encounter notes indicate that during the course of an E/M, a patient complains... Read more
You Be the Coder:
Consider Spence Scale As Developmental Screening
Question: What would be the appropriate CPT® code and ICD-9 code to report when a Sp... Read more
Test Your Pediatric E/M Coding Skills With This Quick Quiz
These questions will evaluate whether your E/M codes are on the straight and narrow. &... Read more
One Billing Question, 4 Steps to Resolution
Don’t take appeals at face value--research before you write off. It happens to e... Read more
Government Collects Record-Breaking $835 Million From Fraudulent Medicaid Billers
For every dollar spent on health care fraud investigations, the government recovered a w... Read more
Know the Rhinitis Cause to Report This Dx Under ICD-10
You’ll be checking the ‘J30.x’ section to find the right rhinitis code... Read more
Reader Question:
Know How to Bill for RNs
Question: How do we get paid for nurse time if our nurse is weighing a premature baby an... Read more
You Be the Coder:
How Can We Bill Extended Time?
Question: One of our asthmatic patients was in the hospital for over a week with pneumon... Read more
New Edit Bundles Immunizations With E/M Services, Causing Rash of Denials
CCI also impacts how you’ll report newborn services with critical care. With... Read more
The Lowdown on CCI:
The Lowdown on CCI:
Know why modifiers are your friend when dealing with CCI bundles Many readers who wrot... Read more
Pediatrician Charged With Healthcare Fraud for Overbilling Medicaid
Physician faces up to ten years in prison for the crime. If you think Medicaid claims ... Read more
Consider 'K' Codes for Umbilical Hernia Services Next Year
You’ll say goodbye to code 553.1 effective Oct. 1, 2014. Umbilical hernias are f... Read more
Reader Question:
ADD Alone Doesn't Warrant Modifier 25
Question: We have many patients with ADD or ADHD. We do yearly exams on these children, ... Read more
Reader Question:
Look to Dx for Repeat Lab Test
Question: A patient came in for a well check. The pediatrician ordered a urinalysis, whi... Read more
Reader Question:
Consider Whether to Re-Report Physical Exam
Question: On an electronic medical record (EMR), do I need to redocument the physical ex... Read more
Reader Question:
Location Doesn't Impact Encounter Status
Question: A hospitalist physician asked my pediatrician to see a premature newborn who f... Read more
Reader Question:
No New Code Describes Paperwork
Question: I’ve heard that CPT® has a new code for reviewing records separate f... Read more
You Be the Coder:
Reporting Units Trumps Use of Modifier 76
Question: We use modifier 76 (Repeat procedure by the same physician or other qualified ... Read more
99468: Know How to Bill for Subsequent Admissions
Discharge and readmission? You can report twice. When CPT® makes adjustments, the ... Read more
Patient Privacy:
Avoid Using These Non-HIPAA Compliant Statements With Patients
We polled patients to find out which HIPAA slip-ups medical practices might be making--t... Read more
2013 Payment:
Congress Votes to Halt Across-the-Board Pay Cuts
Permanent solutions to fix this annual problem did not materialize, however. As many p... Read more
Get to Know Expanded Tonsillitis Code Set That Takes Effect Next Year
You’ll say goodbye to codes 463 and 474.00 effective Oct. 1, 2014. Tonsillitis i... Read more
Reader Question:
Non-Par? Bill the Parents
Question: We have recently had an influx of patients (at least one per week) presenting ... Read more
Reader Question:
Even 10-Day Globals Should Be Taken Seriously
Question: A patient with cerebral palsy saw our pediatrician because of an abscess, and ... Read more
Reader Question:
You Can Bill Critical Care in the Office
Question: Our pediatrician saw two patients who left the office by ambulance. One was in... Read more
Reader Question:
Consider the Law When Patient in Collects Requests Referral
Question: I haven’t seen a particular patient since 2011, and his account is in co... Read more
Reader Question:
99058 Has Unique Requirements
Question: A mother called and reported her baby was having trouble breathing. A nurse re... Read more
Reader Question:
Check With Payer on "Uncooperative" Rescreens
Question: When a certified medical assistant (CMA) performs a screening and cannot get a... Read more
Reader Question:
You Can Bill Time-Based Second Service
Question: Can we use time to select a second E/M code even if the other service code isn... Read more
You Be the Coder:
Provider-Neutral Language Shouldn't Impact Too Harshly
Question: Does our practice need to make any changes to our systems to accommodate the f... Read more
2013 Payment:
99495-99496: Two New Codes Allow You to Report Transitional Care Management Services
Payment assignments to these codes could signal the way for private payer fees. CMS of... Read more
Clip And Save:
Navigate New Intensive Care, Critical Care Transfer Rules
Last month, we told you how CPT® 2013 changes the way you should report neonatal and ... Read more
Electronic Health Records:
Don't Buy Into These 3 Common EHR Fallacies
Protect your pediatric pay by avoiding these mistakes involving electronic health records... Read more
Consider How You'll Code After V20.2 No Longer Exists
Your practice probably performs well child visits each day, but how to report them will ... Read more
Reader Question:
Code Signs/Symptoms When Separate From Definitive Dx
Question: Can I report the diagnosis codes for tonsillitis, pharyngitis and upper respira... Read more
Reader Question:
State Laws Dictate Who the Doc Can Supervise
Question: Can a pediatrician bill as a supervising provider when the staff member (in ou... Read more
You Be the Coder:
Modifiers Might Be Required for Well/Sick Visit Combos
Question: We billed a well-child checkup and a sick visit on the same day. For the sick ... Read more