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Pediatric Coding Alert

CPT® 2015:
Prep Now for Big Changes to Your MCHAT, ADHD Evaluation Coding
Your developmental screening tests will soon be split into two separate codes. Your pr... Read more
Can You Code This Pediatric Note Using Only ICD-10 Codes?
Determine whether you’ll be ready for the new coding system with this sample note.... Read more
Prolonged Service Coding:
Focus on 3 Tips to Capture Deserved Extra Pay With +99354 and +99355
Multiply your payment by ensuring your physicians are using their watch to note accurate... Read more
Clip And Save:
Let This Prolonged Services Chart Help Guide Your Code Selections
If you’re still not sure when you should report the prolonged service codes (+9935... Read more
Reader Question:
Get the Facts on Allergy Testing
Question: One of our private payers denied two types of allergy testing that we rep... Read more
Reader Question:
Mind Your Global Periods
Question:  A patient with cerebral palsy saw our pediatrician because of an abscess... Read more
Reader Question:
Use 94664 for Inhaler Demo
Question: We have never billed for the nurse’s services showing a patient how... Read more
You Be the Coder:
Meet the 'Critical Care' Criteria
Question: Our pediatrician is trying to report a standard hospital care code, where... Read more
Diagnosis Coding:
3 Mythbusters Prove That 'E' and 'V' Codes Can Help Your Case
Don’t ignore these often-overlooked diagnosis codes. Submitting claims for your ... Read more
3 Lessons You Can Learn From These Pediatric Practices' Medicaid Audits
Follow this advice to make sure you aren’t in the hot seat. The word “audi... Read more
Determine Whether You'll Be Able to Code These Diagnoses Next Year
Test yourself with this quick quiz. ICD-10’s implementation is less than a year ... Read more
Reader Question:
Avoid Billing Before Physician Joins Medicaid
Question: We have a new doctor in our practice and she has not been added to our Me... Read more
Reader Question:
Choose One Vision Test to Report
Question: When we perform the Snellin test (99173) on our patients, often the docto... Read more
Reader Question:
Ensure Incision to Report 10120
Question: Our pediatrician removed a pencil tip from a patient’s finger and c... Read more
Reader Question:
Count the Time for Prolonged Services
Question: During a scheduled office visit of an established patient, our physician ... Read more
Reader Question:
Choose From Among Several Diabetes Education Options
Question: A pediatrician and physician assistant are educating some parents on diab... Read more
You Be the Coder:
Create Your MCHAT Policy
Question: If we perform a pediatric test such as the MCHAT, must we retain the comp... Read more
CPT® 2015:
Look for Revised, Updated Chronic Care Management Codes in January
Plus: You’ll find new code for infant hypothermia inducement. Although 2015 migh... Read more
Additional Coding Advice Leads Your ICD-10 Selection
New advice more accurately mirrors the current ICD-9 regulations. Although ICD-10 won&... Read more
Patient Privacy:
Pediatric HIPAA Policies Should Consider Photography Rules
Plus: Laptop theft places hospital in treacherous waters. Recent class-action lawsuits... Read more
Reader Question:
Can You Downcode to 99211 for Incomplete Physician Notes?
Question: A patient presented for a visit but the pediatrician failed to complete t... Read more
Reader Question:
Look for ADHD Changes Under ICD-10
Question: How will we report ADHD under ICD-10? Answer: Using the current ICD-9 c... Read more
Reader Question:
Know the Weight Check Regs
Question: Our coders recommend that we report a newborn weight check using V20.32 (... Read more
You Be the Coder:
Avoid Two E/M Codes
Question: A patient came in to our office complaining of constant headaches. During... Read more
Pediatric Payment:
Global Periods Could Become a Thing of the Past
Plus: Chronic care management pay may be coming your way next year. Although the propo... Read more
E/M Coding:
Mistake ROS Level and You Could Lose $91
Differentiate extended and complete systems review to judge if 99204 wins out over 99203. ... Read more
Find Positive Answers for 'All Others Negative'
Here’s how to handle ROS black holes - and avoid scrutiny There’s no quest... Read more
Government Eyeing Physicians' Relationships With Labs
Latest ‘Special Fraud Alert’ reiterates the shaky ground in lab contact. T... Read more
Reader Question:
Take Mystery out of History
Question: When I audit my physicians’ subsequent hospital care notes, I frequ... Read more
Reader Question:
Focus on 96110 Units
Question: How many units can we report of 96110?  Our coder would like to repo... Read more
Reader Question:
PPD Test May Warrant E/M
Question: Our insurance company bundles an office visit with the code for PPD admin... Read more
You Be the Coder:
Vaccines May Be Based on Age
Question: We administered a DTap vaccine to an eight-year-old child. The physician ... Read more
Modifier 25:
Two Major Payers Change Modifier 25 Policies
You’ll need a new diagnosis for E/M payment from Tufts. Most pediatric practices... Read more
Payment News:
Look for Renewed 69210 Pay From Cigna
The NCCI fight is over for one payer. If you’ve been frustrated by halted reimbu... Read more
Determine Esophagitis Status When Coding Reflux
Starting next year, the single code for reflux expands into two separate choices. Esop... Read more
Prolonged Service Coding:
99358: Unlock the Mystery of Non-Face-to-Face Prolonged Visits
You can report extra time for extended visits with parents. Although you’re fami... Read more
Patient Privacy:
Your Associate's Mistakes Shouldn't Cost You Money
Look out: Private lawsuits can be just as costly as federal HIPAA fines. You might thi... Read more
Reader Question:
Nail Down Lactation Consult Coding
Question: Can a nurse practitioner bill for hospital visits? Our nurse practitioner is a... Read more
Reader Question:
Keep An Eye on the Calendar
Question: The CPT® surgery guidelines state that the surgical package includes ... Read more
Reader Question:
Identify the Correct Form
Question: I used to bill for a facility and am new to the role of practice manager ... Read more
You Be the Coder:
Look for Problem-Oriented ICD-9 Code
Question: Our pediatrician reports code V21.1 (Puberty) when checking puberty level... Read more
E/M Coding:
5 Tips Ensure That You Select the Right E/M Code
Incorrect E/M coding is a $6.7 billion per year problem, OIG says. You may have though... Read more
E/M Coding:
Avoid Rewriting History by Differentiating between 'Brief' and 'Extended' HPI
Take this step toward fixing your E/M documentation. If you’re planning to tight... Read more
CMS Reps Remain Vague on ICD-10 Details
Government officials answer questions by not answering at all. The recent delay of ICD... Read more
Reader Question:
Know the Delivery Bundles
Question: An ob-gyn called our pediatrician into the delivery room for a consult, a... Read more
Reader Question:
Record Reviews Included in E/M
Question: A patient had her past medical records, containing more than 10 years of ... Read more
Reader Question:
Know Who Can Ask for Consultation
Question: I have a provider who documented a consultation note for a patient whom a nurs... Read more
Reader Question:
Blanket ABNs Are Frowned Upon
Question:  I recently started working at a practice that I think overuses ABNs. Can... Read more
You Be the Coder:
School Physicals Can Be Tricky
Question: I have searched for a CPT® code to use with V70.3 for a school physic... Read more
Patient Management:
3 Tips Help You Deal With Parents Frustrated by Copay at 'Free' Well Visit
When a problem is found during a well visit, you may need to charge patients who expect ... Read more
Coding Quiz:
Can You Code These Pediatric Ear, Nose and Throat Maladies?
Test your coding skills against our answers with this quick quiz. Many of the illnesse... Read more
Respond to These 6 Practitioner Complaints About ICD-10
Think we should just ‘wait for ICD-11?’ Here’s why you can’t. ... Read more
Reader Question:
Clarify Screening Vs. Diagnostic
Question: We reported 82270 for a Guaiac test, but the insurer denied it and said i... Read more
Reader Question:
Determine Sick Visit Vs. Camp Physical
Question: We had an asthmatic patient present because she required an Epi-pen to ta... Read more
Reader Question:
It's Time to Use New Claim Form
Question: I need some help concerning the rules for billing on the new CMS-1500 for... Read more
You Be the Coder:
Avoid 99339 for Phone Call
Question: Our doctor spent a long time on the phone with a patient’s mother d... Read more
Correct Coding:
5 Tips Protect Your Pediatric Payments
Tighten up your coding for these common services to ensure you aren’t losing money... Read more
Congress Votes to Delay ICD-10
You have another year before you’ll have to implement the Dx coding system. Rumo... Read more
ICD-10 Spotlight:
Look to 'N' Series for UTI When Oct. 1, 2015 Arrives
ICD-10 offers fairly simple conversion for urinary tract infections. Urinary tract inf... Read more
Vaccine Coding:
These 3 FAQs Will Keep Vaccine Errors to A Minimum
Hint: You won’t always need V20.2. Your pediatric practice probably administers ... Read more
Reader Questions:
Base Allergy Coding on Number of Injections Provided
Question:  If our pediatrician provided allergy shots, what is the correct way to r... Read more
Reader Question:
Cryo Isn't Required for Wart Removal
Question: The pediatrician documented, “Dermatology treatment rendered in the... Read more
Reader Question:
Nail Down Umbilical Hernia Diagnosis
Question:  What is the correct diagnosis code for an umbilical hernia with obstruct... Read more
You Be the Coder:
Watch for CCI Edits on Nebulizers
Question: We recently reported nebulizer treatment (94640) with an E/M visit and th... Read more
ICD-10 Quiz:
Will You Know How to Code These Diagnoses in October?
CMS confirms that the implementation date won’t be postponed. You are already aw... Read more
E/M Coding:
Spot the Problem in This E/M Note
Read thoroughly to determine whether you can see where this practice forfeited money. ... Read more
5 FAQs Nail Down Your Billing Expertise
Hint: Copays only apply when billing the insurer. Most pediatric practices have been s... Read more
Reader Question:
You Can 'Look Back' at History
Question:  The pediatrician documents “PMFSH: Same as documented in my note o... Read more
Reader Question:
Avoid Admit and Office Visits Together
Question:  Our pediatrician saw a patient in the office, then admitted her to the h... Read more
You Be the Coder:
Know the Critical Care Rules
Question: A child less than five months old was admitted into the ICU, then our ped... Read more
Time-Based Coding:
Time Is on Your Side When Coding Pediatric Notes
Let these three answers guide your time-based E/M coding quandaries. Pediatricians are... Read more
Pediatric Payment:
Bilateral Cerumen Removals Could Prompt Denials
Private payers may follow Medicare’s lead, which could hurt your bottom line. Wh... Read more
ICD-10 Coding:
Look for Major Expansion of Stye Codes in October
You must document the site if you want to collect under ICD-10. A stye is an infection... Read more
3 Payers, 3 Sets of Modifier 25 Rules
Think all modifier 25 policies are the same? Think again. You’ve finally waded t... Read more
Reader Question:
Hospital Bills Dubowitz-Ballard
Question: Our pediatrician performed a Dubowitz Ballard Exam for gestational age on a pr... Read more
Reader Question:
Consider Your No Show Policy to Be Flexible
Question: During the snow storm last week, we had several patients call in and say they ... Read more
Reader Question:
No E/M, No Modifier 25
Question: A patient came in because he had an abscess on his finger (no other problems).... Read more
Reader Question:
Urinalysis Prompting Follow-up Is Payable
Question: If our office performs a dipstick urinalysis and then finds something is abnor... Read more
Reader Question:
Look to V Codes for Screening
Question: A patient presented to our office for a scoliosis screening. We were searching... Read more
Reader Question:
Collect Insurance Cards Frequently
Question: A patient came to our office. The physician performed an exam and administered... Read more
You Be the Coder:
Know the Rules for 69210
Question: A patient presented to our practice with ear pain, but the pediatrician had to... Read more
Use These 3 FAQs When Coding VFC Products
Keep in mind, however, that state rules may vary. Your practice is most certainly fami... Read more
E/M Quiz:
Test Your E/M Coding Skills With This Quick Quiz
Then see below to check your answers. Most pediatric practices would agree that E/M co... Read more
Tighten up Your Documentation in 5 Quick Steps
Yes, EMRs improve legibility: But they may lead to other issues. When your pediatric p... Read more
Prep Now for New Pneumonia Diagnosis Code
Starting this October, you’ll be required to report J18.9 for pneumonia. Althoug... Read more
Reader Question:
Look to 96372 for Synagis Injection
Question: Our nurse administered a Synagis injection to a premature baby during a well c... Read more
Reader Question:
Consider the Options for Diabetes Educator
Question: We recently hired a registered nurse who is a Certified Diabetic Educator. How... Read more
Reader Question:
Consider 24640 for Nursemaid's Elbow
Question: Our pediatrician treated a 3-year-old patient for nursemaid’s elbow afte... Read more
You Be the Coder:
Avoid Displaying Patient Names
Question: What guidelines should our group follow to protect the privacy of patient info... Read more
E/M Coding:
Can You Spot the Coding Problem for This E/M Note?
When coding your practice’s charts, it can be easy to gloss over specific informat... Read more
Pediatric Payment:
CMS Keeps Pediatric Pay Stable in 2014
Plus: CMS could allow chiropractors to bill E/M codes next year. CMS offers several bi... Read more
Keep K59.xx in Mind As Your Go-to Diagnosis for Constipation Under ICD-10
Codes in this category fortunately feature a one-to-one crosswalk. Constipation can be... Read more
New Patient Coding:
Follow These 3 FAQs for New Patient Coding Success
Is your patient new or established? We help break down the answers. To accurately repo... Read more
Reader Question:
Don't Let Day Two of Urinalysis Confuse You
Question: A patient came in for a well check. The pediatrician ordered a urinalysis, whi... Read more
Reader Question:
No 'Wrong Dosage' Modifier Exists
Question: Which codes apply if we administer the wrong dosage of medication to a patient... Read more
Reader Question:
Include Pain Meds in E/M
Question: Is there a code that I can use for the administration of Tylenol or Motrin? Th... Read more
Reader Question:
Use of Prednisone Doesn't Dictate E/M
Question: Since prescription management involves moderate risk on the CMS standard docum... Read more
You Be the Coder:
Default to E/M for Toilet Training Issues
Question: Which CPT code would you recommend using when the pediatrician evaluates a thr... Read more