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Pediatric Coding Alert

CCI 22.3:
Latest CCI Edition Includes Vast Debridement Bundles
Know what to do when the debridement code is in column one. Typically when the calenda... Read more
CCI 101:
Are You Familiar With the Basics of CCI?
Tip: Be careful when separating bundled services. If you don’t understand what C... Read more
E/M Coding:
Check Out These 6 E/M FAQs
Hint: E/M format may not matter to an auditor, as long as the information is there. Yo... Read more
Master Your Supply Billing With 4 Quick Tips
Remember: 99070 is not a one-size-fits-all materials code. When it comes to billing fo... Read more
Reader Question:
Look Beyond E/M for Nursemaid's Elbow
Question: Which code applies to nursemaid’s elbow treatment? Our pediatrician... Read more
You Be the Coder:
E/M Codes Cover Oral Pain Medications
Question: Is there a code that I can use for the administration of Tylenol or Motri... Read more
CPT® 2017:
Latest CPT® Edition Overhauls Vaccine Descriptors
You’ll also see changes to 99420 reporting. Coding vaccines based on the patient... Read more
E/M Coding:
3 Tips Lead to Seamless Consultation Coding
Consult coding is still going strong for some private payers—if you know how to re... Read more
Look to 'Z' Codes When Patients Turns out to Be Healthy
Remember that Z00.129 isn’t your only well-visit option. Pediatric practices are... Read more
Patient Privacy:
3 Essential Steps to Take After A HIPAA Breach
Know the ropes, no matter how big or small the breach was. Your pediatric practice may... Read more
Follow These 7 Steps When A HIPAA Breach Happens
Document your investigation carefully in case of a lawsuit. Try as you might to preven... Read more
Reader Question:
Look to Z Code As Secondary In This Situation
Question: If the parents meet with the doctor to talk about the child’s condi... Read more
Reader Question:
Look Deeper for Laryngitis Code
Question: Which code should we report for laryngitis? Subscriber ... Read more
Reader Question:
Keep Zika Codes Straight
Question: Is there an ICD-10 code for the Zika virus in the 2017 update? Maryland... Read more
You Be the Coder:
Get the Specifics for Adhesion Release
Question: Our pediatrician released a penile adhesion from a patient that had a cir... Read more
Pediatric Mythbuster:
Yes, You Do Need to Follow Global Periods for Minor Procedures
Even if you don’t perform “surgeries,” you are subject to global surgi... Read more
3 Tips to Avoid Medicaid Improper Payment Accusations
CMS says that improper Medicaid claims skyrocketed last year—ensure that you aren&... Read more
Can You Master This Mental Health Coding Quiz?
From ADHD to separation anxiety, see if you can select the correct diagnosis code. Ped... Read more
Reader Question:
HPI Could Make the Difference Between 99212 and 99215
Question: One of our pediatricians is great at documenting the exam and medical dec... Read more
Reader Question:
Heed the "X's" in ICD-10
Question: I’m still getting the hang of using the ICD-10 coding system, but I... Read more
Reader Question:
HPV Vaccines Often Have Age Limits
Question: We have heard conflicting advice about who can receive an HPV vaccine. On... Read more
You Be the Coder:
Time Really Is Money in Pediatric Practices
Question: I read your advice in Pediatric Coding Alert saying to ask patients for t... Read more
3 FAQs Help You Collect for 90460--Which May Bring in More Money Than You Think
Hint: Counseling is not optional with this code. Your practice is probably reporting i... Read more
Latest Fee Schedule Proposal Could Alter How You Use Modifier 25
CMS doesn’t appear happy with the rampant modifier 25 usage on cerumen removal and... Read more
5 Quick Examples Ease Your Otitis Media Diagnosis Confusion
Determine how you’d code these common scenarios. Most pediatric practices can&rs... Read more
Patient Privacy:
Patient Satisfaction Survey Could Belie HIPAA Breach
Sometimes, just being associated with a certain practice is considered a breach. Sure,... Read more
Reader Question:
Look to 'R' Series for Nosebleed
Question: A two-year-old patient came to our practice with a nosebleed that started... Read more
Reader Question:
Find the Positive in 'All Others Negative'
Question: Our pediatrician always marks “all others negative” in the EM... Read more
Reader Question:
Note These Key Speech Therapy Code Differences
Question: When should we use the speech therapy code 92507 versus the cognitive ski... Read more
You Be the Coder:
Don't Look to 90863 for Med Management
Question: Which code(s) should we report to describe our services providing medicat... Read more
Revenue Booster:
Tackle These Common Pediatric CCI Edits to Keep Income Flowing
Remember that modifier 25 can separate edits when appropriate. Dealing with Correct Co... Read more
Practice Management:
3 Quick Tips Help You Conquer These Pediatric Office Challenges
Hint: Keep a backup list of appointments to help quell cancellation woes. Every pediat... Read more
Some Insurers Tweak Diagnosis Rules for Developmental Screens
Look to Z13.4 as secondary code with ages and stages screenings. Most pediatric practi... Read more
Reader Question:
You'll Typically Select POS Based on Your Setting
Question: Our patient went to an outpatient hospital for a test, but then our pedia... Read more
Reader Question:
Let Documentation Drive Code--Even for Follow-up
Question: Our pediatrician saw a patient last week, evaluated her, and drained an a... Read more
Reader Question:
Pediatricians Can File With Medicare
Question: Our providers only see pediatric patients, and therefore we are not enrol... Read more
Reader Question:
Count Time for Observation Claims
Question: One of our pediatricians performed an observation service for a patient t... Read more
Reader Question:
99050 Use May Hinge on Reason for Visit
Question: Can we report 99050 for a walk-in patient who came to our clinic after we... Read more
You Be the Coder:
Analyze Profit and Loss Statements Carefully
Question: I read your article on benchmarking last month with great interest (Vol. ... Read more
Compare Your Pediatric Coding Trends to These National Averages
Crunch these numbers to find out where you stand among other pediatricians. Most pedia... Read more
E/M Services:
Transitional Care Management Income Could Be Moving Faster Into Your Accounts
You no longer need to wait 30 days to submit transitional care management claims, new di... Read more
Reader Question:
Know the Acceptable Documentation Formats
Question: Our pediatrician circled 99213 on his chart, but the only note in the rec... Read more
Reader Question:
Ask for Medical Policy
Question: I contacted my insurer and asked how they prefer me to submit codes for a... Read more
Reader Question:
Will HIPAA Audits Focus on Risk Management?
Question: We read your article on the upcoming HIPAA audits with great interest, bu... Read more
You Be the Coder:
Pediatricians Will Rarely Report 99177
Question: Is 99177 valid for 2016? What’s the difference between this code an... Read more
Latest ICD-10 Updates Offer Several New Pediatric Diagnoses
List of suspected—but ruled out—pediatric conditions has grown. The CDC ha... Read more
Screening Tests:
Avoid 99211 for PKU Tests
Plus: Pay attention to who actually performs the lab test. Pediatricians perform pheny... Read more
HIPAA Audits Impacting Practices Nationwide
Prep now in case you get the call. You’ve been hearing for years that HIPAA audi... Read more
Reader Question:
Get More Details for Otitis Media Dx
Question: We are at a loss regarding how to report otitis media for a two-month-old... Read more
Reader Question:
Buddy Taping Counts as Strapping
Question: A patient reported to our office limping badly after falling off the jung... Read more
Reader Question:
Get the Details on 'New' Patients
Question: An intensive care physician asked my pediatrician to see a premature newb... Read more
Reader Question:
Sunburn Coding Depends on Severity, Treatment
Question: Our physician treated a four-year-old patient with a bad sunburn. We were... Read more
Reader Question:
Look to 94010 for Spirometry
Question: A 14-year-old established patient presented for a follow-up visit after a... Read more
You Be the Coder:
SA Modifier May Not Be Required
Question: We employ a nurse practitioner (NP) at our office, and when she provides ... Read more
2016 News:
Consider These 3 CCI Manual Changes Before Coding Your Pediatric Services
The guidelines finally address how you should break down your time-based codes. The Co... Read more
Confirm Obesity Specifics for Diagnosis Coding Options
Yes, even pediatric patients can reach the ‘morbid’ category. In the not-t... Read more
Medical Records:
Government Urges Practices to Stop Charging Patients for Medical Records
Although you can legally charge patients for sending their records, HHS appears to disco... Read more
How Much Can You Charge?
The Department of Health and Human Services technically allows practices to charge a fee... Read more
What If the Patient Disagrees With the Information in Her Records?
It happens from time to time—you share a copy of the patient’s medical recor... Read more
Reader Question:
94664 Is Best Bet for Asthma Education
Question: We are starting to do asthma education with our asthma follow-up patients... Read more
Reader Question:
Look to 99188 for Fluoride
Question: Our pediatrician brushed fluoride onto a patient’s teeth. Can we re... Read more
Reader Question:
Look to 99078 for Group Training
Question: Our physicians would like to perform group visits for about eight to ten pa... Read more
Reader Question:
Documentation Reigns for Cerumen Removal
Question: I enjoyed your article on the new cerumen removal code 69209 (Removal imp... Read more
You Be the Coder:
Correction: Avoid 'X' Modifiers for E/M Codes
Question: In the Vol. 19, no. 4 issue of Pediatric Coding Alert, a reader asked whe... Read more
E/M Coding:
No Patient in the Room? No Problem
You can still bill an E/M code based on time to most insurers. It happens in pediatric... Read more
Confirm These 3 Elements Are in the Documentation for Time-Based coding
Before using time as the controlling factor, check off the following requirements that m... Read more
Prolonged Service Coding:
New Prolonged Service Codes Look Great--But Can You Collect for Them?
Some payers are reimbursing 99415-99416, while others have balked. When CPT® 2016 ... Read more
Slightly Tweaking Your Patient Registration Questions Could Increase Your A/R
Ask pointed questions to get better information from patients, this billing expert says.... Read more
Let 'Z' Codes be Your Friends When Ordering Neonatal Tests
Pediatricians frequently order tests on newborns, often requiring your office to provide... Read more
Reader Question:
Avoid 87502 for Most Office Flu Tests
Question: We are very confused about how to code for influenza tests. When billing ... Read more
Reader Question:
Some Payers May Want Modifier 25 Despite Add-on Nature
Question: United Healthcare recently denied a claim, saying that we should have add... Read more
Reader Question:
Look to 'H' Series for Eustachian Tube Dx
Question: Eustachian tube dysfunction had a specific code in ICD-9 (381.81), but in... Read more
Reader Question:
Don't Collect 2 Copays for Dual Visits
Question: If a patient comes in twice in one day because he feels worse later on in... Read more
You Be the Coder:
Look to 99420 for Mother's Postpartum Screening
Question: We are planning to start performing postpartum screenings on the mothers ... Read more
Cerumen Removal:
This Payer Outlines How to Collect for New Cerumen Removal Code 69209
Plus: CCI weighs in on the issue. It’s been active for over a month now, but new... Read more
Random-Order Diagnoses Could Cost You
Implement this ICD-10 action plan to decide which diagnosis should go first. In situat... Read more
Electronic Health Records:
Follow 3 Quick Steps to Calm Down If Your EHR Acts Up
No one wants an EHR to go offline, but you can avoid panic with these simple steps. Yo... Read more
Reader Question:
Cheat Sheets Are Just a Starting Point
Question: We have been training our new pediatricians to use the superbills we prin... Read more
Reader Question:
Discharge Code Limited to One Provider
Question: One of our patients had a complex health history and we were among four d... Read more
Reader Question:
Consult Guidelines for Tricare Coverage
Question: I remember hearing that Tricare covers speech therapy but we keep getting... Read more
Reader Question:
Correct EHR Entries As You Would Paper
  Question: We are aware of how to correct a mistake on a paper medical reco... Read more
You Be the Coder:
Can You Define 'Normal?'
Question: We almost always report normal newborn care codes for the pediatrician&rs... Read more
Pediatric Mythbuster:
Can Existing Problem Qualify You to Use Modifier 25?
You may be surprised when we bust this commonly-held coding myth. It’s a frequen... Read more
Support Higher-Level Family Counseling Sessions Using 7 'Z' Codes
This series helps show why $64 more for a 99214 could be in order. Still don’t h... Read more
Latest 'Excludes1' Guideline May Alter Your Diagnosis Coding
You’ve been using ICD-10 for nearly four months now, so it’s likely that you... Read more
These 2 Simple Billing Tips Can Save You Thousands
Easy and inexpensive to implement, you’ll benefit from instituting these expert po... Read more
Reader Question:
Differentiate New Vs. Established for Medical Assistant
Question: If our medical assistant sees a new patient for a flu shot only, and the ... Read more
Reader Question:
This Lab Code Isn't Dependent on Place of Service
Question: Is 99214 payable if coded with 81001 when the place of service is 22? Is ... Read more
Reader Question:
Bill for Each Vanderbilt
Question: When the pediatrician scores and interprets multiple Vanderbilt screening... Read more
You Be the Coder:
Tick Investigation Warrants E/M
Question: Is there a code to bill if the pediatrician examines a tick under a micro... Read more
Preventive Care:
5 Vaccine Answers Straight From Your Payers
Hint: Know the HPV vaccine coverage ages for your insurer. Immunizations likely make u... Read more
OIG Will Take A Closer Look at These Pediatric Issues in 2016
Button up your prolonged service codes. Billing for prolonged services may have just g... Read more
Know How ICD-10 Transforms the Way You Code These Services
Keep these tips in mind as you report your services. Although most practices report a ... Read more
Reader Question:
Ask Payers About Coordination of Care Rules
Question: Our pediatrician makes a lot of phone calls to patients’ parents and oth... Read more
Reader Question:
Mind the Rules for Chart Amendments
Question: One of our pediatricians made mistakes on several charts and printed out new d... Read more
Reader Question:
Look to Modifiers for Sick/Well Visit Combo
Question: We frequently have babies present for well visits but the doctor finds a probl... Read more
Reader Question:
Check Age for Circumcision Patient
Question: Our pediatrician has never performed a circumcision in the office before, but ... Read more
Reader Question:
Tricare Is Usually Secondary
Question: We had a patient present with Tricare insurance and we billed the claim to Tri... Read more
You Be the Coder:
Don't Base E/M Level on Dx
Question: Which code should we report for evaluation of an ear ache, sore throat, runny ... Read more