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Pediatric Coding Alert

Pediatric Payments:
Humana: Use 'X Modifiers' When Applicable
Plus: Two other payers sound off on their specific claim tips. When it comes to payer ... Read more
5 Coding Professionals Share Their ICD-10 Experiences
Plus: Here’s when you can report ‘abnormal findings’ during well child... Read more
Asthma Coding:
5 Quick Tips Help Perfect Your Inhaler Education Claims
Hint: Nebulizer training is indeed billable. There’s no doubt that you occasiona... Read more
Reader Question:
Tread Carefully With 'Other' ICD-10 Codes
Question: If I find that a common ICD-9 code that I use doesn’t have a direct... Read more
Reader Question:
Look to 'Z' Codes for Medication Oversight
Question: For an electrocardiogram (ECG) (93000-93010, Electrocardiogram, routine E... Read more
Reader Question:
Explain Options When Free Visit Sparks Copay
Question: Most of our patients know that under the Affordable Care Act, patients ge... Read more
Reader Question:
Note Site for Nursemaid's Elbow
Question: Our pediatrician treated a three-year-old patient for nursemaid’s e... Read more
You Be the Coder:
Break out the Modifiers for Flu Vaccine
Question: A new patient presented for a flu shot only, but the doctor had to at lea... Read more
E/M Coding:
Keep An Eye on the Calendar to Avoid Same Date Admission, Discharge Denials
Keep track of when the admission actually takes place. You may never collect the $121 ... Read more
Data Breaches Climb in First Half of 2015
Breaches rose by 10 percent in first half of this year versus last year’s num... Read more
Check Out This Sample Social Media Testimonial Authorization
If your HIPAA compliance stops with the standard form you printed off the internet, you ... Read more
Stick to 28-Day Threshold for 'Newborns' Under ICD-10
Look for feeding problem codes in the P92 range. Although the 779.xx series may have b... Read more
Reader Question:
No Problem, No Face-to-Face Visit, No Code
Question: A parent of a large family came into the office with two sick children wh... Read more
Reader Question:
Include NSAID in E/M Documentation
Question: Is there a code that I can use for the administration of Tylenol or Motri... Read more
Reader Question:
Reconsider When Coding Multiple Parings
Question: Our pediatrician recently removed some hyperkeratotic lesions that a pati... Read more
You Be the Coder:
Don't Count on Pay for 99051
Question: We are looking to hire a pediatrician, but in the meantime our schedule i... Read more
CPT® 2016:
New Code Will Describe Cerumen Removal with Irrigation
Plus: CPT® 2016 will debut new x-ray codes for scoliosis evaluations. As most pedi... Read more
3 Pediatric ICD-10 Tips That You Probably Haven't Heard Before
With ICD-10 implementation just days away, nail down these strategies for clean claims. ... Read more
Electronic Health Records:
Report: Doctors Remain Frustrated With EHRs
Use these tips to quell your practice’s EHR issues. When your electronic health ... Read more
We'll Convert ICD-10 Claims to ICD-9 Before Processing
California’s Medicaid payer isn’t quite ready to accept ICD-10 codes. Alth... Read more
Reader Question:
P-Code Is Now Your Best Bet for Jaundice
Question: I’ve heard conflicting advice on how to report jaundice under ICD-1... Read more
Reader Question:
Diabetes Codes Are Now Separated
Question: Our practice sees patients with both type I and type II diabetes, but it ... Read more
Reader Question:
Cerumen Coding Gets Site-Specific
  Question: Which code will replace 380.4 (Impacted cerumen) under ICD-10? ... Read more
Reader Question:
J Codes Reign for Strep and Laryngitis Diagnoses
Question: How will the laryngitis and strep throat codes change now that ICD-10 is ... Read more
You Be the Coder:
Look for Dedicated Asperger's Code
Question: We are accustomed to reporting the “other specified pervasive devel... Read more
Influenza Coding:
These 5 Tips Will Help You Collect for Flu Visits This Season
From immunizations to diagnoses, get the lowdown on flu patients. It’s that time... Read more
Patient Privacy:
Expert: Transmitting PHI Via Text An 'Insidious Problem'
Plus: The majority of HIPAA breaches don't involve deliberate disclosures. Based on evide... Read more
Reader Questions:
Some Payers Bundle E/M, Urinalysis
Question: Which modifier would allow us to report urinalysis code 81003 along with ... Read more
Reader Questions:
Capture All Aspects of Injury
Question: A 10-year-old established patient fell from his bicycle and reported for ... Read more
You Be the Coder:
Lean Toward Consults When You Can
Question: We have two specialists in our group, one of whom is a pediatric endocrin... Read more
Pediatric Mythbuster:
90863 Is Not Your Best Bet for ADD Follow-up Visits
E/M codes will likely be more appropriate for your pediatrician’s services. Your... Read more
Patient Privacy:
Bust These 4 PHI Disclosure-Related Myths
Hint: Patients should be allowed access to their records. Healthcare consultants repor... Read more
Will You Be Able to Code These 3 Pediatric Case Studies in October?
Hint: Signs and symptoms codes may change, but the rules won’t. It’s a com... Read more
E/M Coding:
Ensure Medical Necessity Before Leveling Your E/M Services
Key: MDM and medical necessity are not the same. If you are reporting high level E/M c... Read more
Reader Questions:
Answer: Continue Billing Well Care With Preventive Codes
Question: Under ICD-10, can I still use the 99391-99395 with the Z00.129 along with... Read more
Reader Questions:
Consider Observation Outpatient
Question: A pediatrician admitted and discharged a patient to observation status fo... Read more
You Be the Coder:
Don't Automatically Add -25
Question: Can I charge for a 99213 and a 17250 on the same day at the same visit if... Read more
Payer Guidelines:
5 Facts You Must Know About Tricare
Bill Tricare after private payers, but before Medicaid. Whether your office is right n... Read more
'Z' Marks the Spot for Well Child Visits in October
Keep in mind, however, that your CPT® codes will stay the same. With ICD-10 barrel... Read more
Antibiotic Injection? Report More Than One Code
Dust off your HCPCS manual so you don’t lose out on Rocephin pay. It’s a c... Read more
Is Your Pediatric Practice Making These 10 Common Compliance Mistakes?
Check out these misconceptions and why you shouldn’t keep believing them. Think ... Read more
Reader Questions:
Use Discretion With 'New' Patient Status
Question: If one of our pediatricians referred a patient to one of our nurse practi... Read more
Reader Questions:
Avoid Consult Code for Pre-Op Check with Well Visit
Question:  Our practice in in a heated discussion about an issue and we can’t... Read more
Reader Questions:
Look Deeper When Coding RAD
Question: Which is the correct diagnosis code for reactive airway disease (RAD)? Answe... Read more
You Be the Coder:
Tread Lightly When Patient Steps on Splinter
Question: A pediatrician removed 12 splinters. Should I bill for each splinter remo... Read more
3 Well Visit Facts That May Shock You
Check out the official word on these preventive coding scenarios Just about every pedi... Read more
Even CMS Advises Waiting to Use X{EPSU} Modifiers
There is ‘no benefit’ to using the new modifiers at this point, government r... Read more
Can You Code This Nosebleed Visit?
Plus: ICD-10 will not be further delayed—expect Oct. 1 implementation. Let&rsquo... Read more
Reader Questions:
Know the Bluetooth Risks
Question: Our clinicians use smartphones and tablets. Some of these devices have Bl... Read more
Reader Questions:
Expand Your Allergy Knowledge
Question: Our pediatrician saw a new patient for a wellness visit and wrote that sh... Read more
Reader Questions:
Nurse's Time Is Valuable
Question:  Often, a parent will come in just for a baby’s weight check, but a... Read more
Reader Questions:
Remember 'V' Code for Patients Who Pull Their Ear
Question: A mother brought in an infant saying that the baby had been pulling at his ear... Read more
Reader Questions:
Get to Know HPV Counseling Rules
Question: An established patient came into our ob-gyn office with her mother and th... Read more
Reader Questions:
Determine Tick Removal Method
Question: A father brought his daughter to our office and asked the pediatrician to... Read more
You Be the Coder:
Your Practice Bears Cost of Interpreter
Question: Parents that are deaf selected our practice for their newborn son. When t... Read more
Is Your Newborn Care Documentation Missing This One Crucial Factor?
Scrutinize the notes for discrepancies before selecting your code. Although you might ... Read more
3 Recent Cases Show Pediatric Fraud Vulnerabilities
Tighten up your practice’s compliance plan to ensure audit success. State Medica... Read more
Your Top 3 ICD-10 Questions-Answered
Hint: Keep on using your modifiers the same way after Oct. 1 With the ICD-10 implement... Read more
These 6 Tips Will Transform Your Accounts Receivables
Coordinate back office and front desk staff to keep cash flow positive. You know you&r... Read more
Reader Questions:
'No Charge' Visits Still Count Toward Established Patient Status
Question: Our pediatrician saw a patient during a quick assessment last year at no ... Read more
Reader Questions:
Tylenol Administration Isn't Separately Billable
Question: Our physician saw a patient with a fever—he had her take Tylenol or... Read more
Reader Questions:
Look to 94780-94781 for Car Seat Testing
Question: We often show patients how to maneuver the car seat and recently heard this... Read more
You Be the Coder:
Heed Insurer Preference on New Patients
Question: If a provider of a different specialty within the same group sees the sam... Read more
E/M Coding:
Know How to Carve Out Time for Preventive/ Sick Split Visit
Tip: Keep an eye on the clock to ensure you’re billing accurately for time spent. ... Read more
Chronic Care Management:
Include These 9 Musts into Your CCM Routine
Referring doc isn’t online? You may not be able to collect for CCM. Although you... Read more
What Are Private Payers Saying About CCM?
If your payer follows CMS rules, then Marshall’s advice during the agency’s ... Read more
Who Can Provide Chronic Care Management?
If you’re wondering which of your practitioners can provide chronic care managemen... Read more
Incident To:
Determine Whether Patient's Medical Condition Qualifies As 'New' to Heed Incident To Rules
Hint: Texas Medicaid recently changed its incident to rules. A new condition to you ma... Read more
Reader Questions:
Look for V20.2 Alternative
Question: One of our insurers just denied a claim for a 12 day-old child’s prevent... Read more
Reader Question:
Look to State Guidelines for 90-Day Supplies
Question: We have patients who have instructions from their employers to get a 90-day dr... Read more
You Be the Coder:
Same Day Hospitalization Only Bundled With Same Doc
Question: My colleague said that if a child is admitted to the hospital on the same... Read more
CPT® 2015:
Guide Your Behavioral Assessment Coding With These Quick Tips
Surprise: The AAP still recommends billing the MCHAT with 96110. You’re aware of... Read more
Can You Code This Pediatric Case Study?
Hint: No need to code symptoms that are inherent in the final diagnoses. With just six mo... Read more
Do You Know How to Avoid These 5 Types of Medicaid Fraud?
Medicaid auditors could be reviewing your files—make sure you aren’t violati... Read more
E/M Coding:
Here's Why You Might Be Losing $35 Per Visit
Knowing what to look for in documentation is the key to deciding outpatient visit leveli... Read more
Reader Question:
Consider Modifiers for Two Flu Tests
Question: If our practice tests in the office a rapid flu test for both strains A a... Read more
Reader Question:
You'll Need 2 Reasons for Home Visit
Question: Our pediatrician saw an unvaccinated established patient at the patient&r... Read more
Reader Question:
Don't Feel Required to Tie Concussion to Unconsciousness
Question: We went to a seminar where they said to only report a concussion diagnosi... Read more
You Be the Coder:
Specify Number of HCPCS Units
Question: What’s the correct way to bill Bicillin, and how many units should ... Read more
10 Pediatric Procedures That Can Bring in Cash
If you perform these services, go beyond the E/M codes to boost your revenue. Although... Read more
Can You Code This Asthma Case Study?
Try to use CPT®, ICD-9 and ICD-10 codes for this visit. Now that the calendar has ... Read more
Your Screenings May Warrant Modifier 33
This modifier could ensure that your preventive claims don’t sink. Since your pe... Read more
Patient Privacy:
Emergencies Don't Trump Your HIPAA Requirements
Know what information you can share with disaster relief organizations. Do you know yo... Read more
Reader Question:
Nail Down Answers to After Hours Codes
Question: I have three questions about using 99051: 1. Should we use 99051 in add... Read more
You Be the Coder:
Select Accurate Chief Complaint
Question: Our pediatrician documents most of his chief complaints as “follow-... Read more
Pediatric Payment:
Global Periods to Phase out, Final Fee Schedule Confirms
Plus: You will see an extra $40.39 for every month of chronic care management. When th... Read more
OIG Sets Sights on Medicaid Overpayments
The latest Work Plan focuses on several new areas. This year, you’ll want to mak... Read more
Bust These 3 Myths to Speed Head Injury Claims
You have several options for treating cognitive defects. When your pediatric patients ... Read more
Can You Code This ICD-10 Documentation?
Evaluate the note and then select the right codes. With less than a year before ICD-10... Read more
Reader Question:
Ritalin Monitoring Requires Additional Questions
Question: If our pediatrician performed an electrocardiogram (ECG) (93000-93010, El... Read more
Reader Question:
Avoid ED Codes in the Office
Question: Our pediatrician saw a patient in his office for an emergency—a pat... Read more
You Be the Coder:
Half-Dose of Vaccine May Require Second Visit
Question: Our pediatrician sometimes administers a half dose of flu vaccine instead... Read more