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Pediatric Coding Alert

Master These 4 Pediatric-Specific Modifier 25 Issues

Hint: When billing both well and sick child visit, put modifier 25 on the sick visit code. Want to collect for both a procedure and an E/M service, or a sick and well visit performed during the same appointment? Then modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is your friend. Pediatric practices need to know how to use this modifier properly, or your payer could deny your claim. You can collect prompt payment by avoiding the following four problems that will land your claims on the insurer's hot list. Problem 1: No Separate E/M 'HEM' If you report an E/M visit and a procedure together, you not only need to describe the procedure you performed--you must have a separate and distinct E/M evaluation with supporting documentation. For example: Documentation shows that a pediatrician provides [...]

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