Pediatric Coding Alert
News You Can Use:
Get to Know the 2025 ICD-10-CM Code Set
See how obesity coding is getting more precise. With more than 250 new diagnosis codes, t... Read more
Get to Know the 2025 ICD-10-CM Code Set
See how obesity coding is getting more precise. With more than 250 new diagnosis codes, t... Read more
Telehealth:
Keep Up With These Changes to Post PHE Telehealth
And get ready for telehealth codes to change again in 2025. During her HEALTHCON 2024 pr... Read more
Keep Up With These Changes to Post PHE Telehealth
And get ready for telehealth codes to change again in 2025. During her HEALTHCON 2024 pr... Read more
Practice Management:
Boost Financial Literacy with This Expert Advice
Hint: Make sure you involve physicians, so they understand the ripples of their work. Ma... Read more
Boost Financial Literacy with This Expert Advice
Hint: Make sure you involve physicians, so they understand the ripples of their work. Ma... Read more
You Be the Coder:
Location Is Key for Correctly Coding UTIs
Question: Our pediatrician diagnosed a patient with a urinary tract infection (UTI),... Read more
Location Is Key for Correctly Coding UTIs
Question: Our pediatrician diagnosed a patient with a urinary tract infection (UTI),... Read more
Reader Questions:
Check the Guidelines for This R10 Rule
Question: Can I use an R10.- code without a definitive diagnosis? Minnesota Subscri... Read more
Check the Guidelines for This R10 Rule
Question: Can I use an R10.- code without a definitive diagnosis? Minnesota Subscri... Read more
Reader Questions:
Abide by State Regulations for Minors
Question: We have a 17-year-old patient who has requested that we not discuss their c... Read more
Abide by State Regulations for Minors
Question: We have a 17-year-old patient who has requested that we not discuss their c... Read more
Case Study Corner:
Correctly Code These RSV Bronchiolitis Cases
Also: review the RSV testing codes. One of the most common diagnoses that pediatricians s... Read more
Correctly Code These RSV Bronchiolitis Cases
Also: review the RSV testing codes. One of the most common diagnoses that pediatricians s... Read more
Allergy Testing:
Avoid Allergy Testing, Immunotherapy Coding Traps
Check your answers to these common allergy questions to keep claims on track. Every codin... Read more
Avoid Allergy Testing, Immunotherapy Coding Traps
Check your answers to these common allergy questions to keep claims on track. Every codin... Read more
Denials and Appeals:
Fight for Your Right to Appeal and Win
Insurance companies aren't advocating for your office; that's your job. During her HEAL... Read more
Fight for Your Right to Appeal and Win
Insurance companies aren't advocating for your office; that's your job. During her HEAL... Read more
Reader Questions:
Proof of a Prescription is Not Proof of an E/M Service
Question: An established patient came in for a routine immunization. The physician's ... Read more
Proof of a Prescription is Not Proof of an E/M Service
Question: An established patient came in for a routine immunization. The physician's ... Read more
Reader Questions:
Beware of Damaging Disclaimers
Question: One of the physicians at our practice uses dictation software, and the vend... Read more
Beware of Damaging Disclaimers
Question: One of the physicians at our practice uses dictation software, and the vend... Read more
Reader Questions:
Know Which Guideline to Follow for SDoH Advice
Question: Should I be reporting every social determinant of health (SDoH) that applie... Read more
Know Which Guideline to Follow for SDoH Advice
Question: Should I be reporting every social determinant of health (SDoH) that applie... Read more
Reader Questions:
Heed This Infant Feeding Scenario
Question: A new mother comes in with her 2-month-old because the baby is having troub... Read more
Heed This Infant Feeding Scenario
Question: A new mother comes in with her 2-month-old because the baby is having troub... Read more
You Be the Coder:
Gain Insight Into This Anorexia Case
Question: My physician diagnosed a patient with anorexia. I'm confused about how to ... Read more
Gain Insight Into This Anorexia Case
Question: My physician diagnosed a patient with anorexia. I'm confused about how to ... Read more
EM Coding:
Apply Sports Medicine Know-How to Your E/M Understanding
Gain specific insight into the MDM elements. This time of year, school-aged athletes are... Read more
Apply Sports Medicine Know-How to Your E/M Understanding
Gain specific insight into the MDM elements. This time of year, school-aged athletes are... Read more
ICD-10 Coding:
Learn to Differentiate Among Headache Codes
Also: review the migraine code set. Headaches come and go, and many people just chalk th... Read more
Learn to Differentiate Among Headache Codes
Also: review the migraine code set. Headaches come and go, and many people just chalk th... Read more
Modifiers:
Know These Modifier QW Dos and Don’ts
Hint: Check the CLIA list every time you're submitting a new lab test. Some coding modi... Read more
Know These Modifier QW Dos and Don’ts
Hint: Check the CLIA list every time you're submitting a new lab test. Some coding modi... Read more
Reader Questions:
Look to Provider Discretion for Correct I&D Codes
Question: What's the difference between simple/single incision and drainage (I&D)... Read more
Look to Provider Discretion for Correct I&D Codes
Question: What's the difference between simple/single incision and drainage (I&D)... Read more
Reader Questions:
Know When a Post-Test Case Calls for Symptom Coding
Question: Shouldn't I always be reporting a definitive diagnosis after a procedure or... Read more
Know When a Post-Test Case Calls for Symptom Coding
Question: Shouldn't I always be reporting a definitive diagnosis after a procedure or... Read more
You Be the Coder:
Understand Lund-Browder Method to Code This Burn Case
Question: A 15-year-old boy saw our pediatrician with second-degree burns to his upper ba... Read more
Understand Lund-Browder Method to Code This Burn Case
Question: A 15-year-old boy saw our pediatrician with second-degree burns to his upper ba... Read more
Preventive Service Coding:
Prepare for Proper Preventive Service Coding
Get the scoop on in-house blood testing codes. In the world of pediatric medicine, preven... Read more
Prepare for Proper Preventive Service Coding
Get the scoop on in-house blood testing codes. In the world of pediatric medicine, preven... Read more
Practice Management:
Overcome 2023 E/M Update Challenges with Expert Advice
Get tips on how and when to query. For outpatient pediatric coders, the evaluation and ma... Read more
Overcome 2023 E/M Update Challenges with Expert Advice
Get tips on how and when to query. For outpatient pediatric coders, the evaluation and ma... Read more
Technology:
Conquer Remote Patient Monitoring Obstacles
Also: See what the FDA considers a medical device. In this age of telehealth and increa... Read more
Conquer Remote Patient Monitoring Obstacles
Also: See what the FDA considers a medical device. In this age of telehealth and increa... Read more
Reader Questions:
Reevaluate the Relationship Between Unlisted Codes and Modifiers
Question: Can I append a modifier to an unlisted CPT® code? I'm having trouble getti... Read more
Reevaluate the Relationship Between Unlisted Codes and Modifiers
Question: Can I append a modifier to an unlisted CPT® code? I'm having trouble getti... Read more
You Be the Coder:
Serve Correct Coding in This Tennis Elbow Case
Question: The provider saw a new teenage patient who was complaining of pain in the r... Read more
Serve Correct Coding in This Tennis Elbow Case
Question: The provider saw a new teenage patient who was complaining of pain in the r... Read more
FAQs:
Clearly See the Answers to These Vision Screening FAQs
Also: find guidance on billing vision screenings with well-child visits. When it comes t... Read more
Clearly See the Answers to These Vision Screening FAQs
Also: find guidance on billing vision screenings with well-child visits. When it comes t... Read more
Condition Spotlight:
Cut Into Common Lesion Removal Codes
Also: see when and how to append modifier 59. Removal of small, benign lesions, such as w... Read more
Cut Into Common Lesion Removal Codes
Also: see when and how to append modifier 59. Removal of small, benign lesions, such as w... Read more
Practice Management:
Use This Guidance to Improve Your Coding Education Process
Check out these tips for more effective onboarding. Coding education is an ongoing effort... Read more
Use This Guidance to Improve Your Coding Education Process
Check out these tips for more effective onboarding. Coding education is an ongoing effort... Read more
Reader Questions:
Wade Through Dermatitis Codes to Report This Rash
Question: We recently saw a young patient who presented with small, raised bumps on h... Read more
Wade Through Dermatitis Codes to Report This Rash
Question: We recently saw a young patient who presented with small, raised bumps on h... Read more
Reader Questions:
Stick to the Facts to Find the MDM Level
Question: Our pediatrician saw a patient who complained of persistent flu-like sympto... Read more
Stick to the Facts to Find the MDM Level
Question: Our pediatrician saw a patient who complained of persistent flu-like sympto... Read more
Reader Questions:
Up Your Bulimia Coding Know-How
Question: Our pediatrician diagnosed a teenaged patient with binge-eating disorder. ... Read more
Up Your Bulimia Coding Know-How
Question: Our pediatrician diagnosed a teenaged patient with binge-eating disorder. ... Read more
You Be the Coder:
Keep Your Eye on Patient Age for This Case
Question: We recently saw a 4-day old infant who presented with a yellowish discharge... Read more
Keep Your Eye on Patient Age for This Case
Question: We recently saw a 4-day old infant who presented with a yellowish discharge... Read more
ICD-10:
Review These Skin-Related Terms and Conditions
Find guidance on selecting the correct dermatitis codes. As medical coders, you understan... Read more
Review These Skin-Related Terms and Conditions
Find guidance on selecting the correct dermatitis codes. As medical coders, you understan... Read more
Condition Spotlight:
Never Again Get Lost While Coding Pharyngitis
Hint: Exposure to smoking may be relevant. Coding pharyngitis may seem cut-and-dried, but... Read more
Never Again Get Lost While Coding Pharyngitis
Hint: Exposure to smoking may be relevant. Coding pharyngitis may seem cut-and-dried, but... Read more
Practice Management:
Think Twice Before Waiving Co-Pays
See how a simple financial accommodation can cause a huge headache. Healthcare practitio... Read more
Think Twice Before Waiving Co-Pays
See how a simple financial accommodation can cause a huge headache. Healthcare practitio... Read more
Reader Questions:
Delve Into This Diabetes Scenario
Question: We have a 17-year-old patient recently diagnosed with diabetes. The notes s... Read more
Delve Into This Diabetes Scenario
Question: We have a 17-year-old patient recently diagnosed with diabetes. The notes s... Read more
Reader Questions:
Consider These Newborn Hearing Screening Coding Options
Question: What is the correct way to code hearing screenings performed on newborns or... Read more
Consider These Newborn Hearing Screening Coding Options
Question: What is the correct way to code hearing screenings performed on newborns or... Read more
You Be the Coder:
Solve this Same-Day E/M Situation
Question: I'm trying to code an encounter where a family consulted with a provider bu... Read more
Solve this Same-Day E/M Situation
Question: I'm trying to code an encounter where a family consulted with a provider bu... Read more
Condition Spotlight:
Clean Up Your Comprehension Surrounding Bronchitis Coding
See when it's appropriate to report an unspecified code. If there is one thing that pedi... Read more
Clean Up Your Comprehension Surrounding Bronchitis Coding
See when it's appropriate to report an unspecified code. If there is one thing that pedi... Read more
CPT® Coding:
Solidify Your Understanding of Static and Dynamic Splints
Increase your insight into laterality modifiers. Spring is here, which means kids are hea... Read more
Solidify Your Understanding of Static and Dynamic Splints
Increase your insight into laterality modifiers. Spring is here, which means kids are hea... Read more
Practice Management:
Don’t Let New Tech Introduce New Cyber Threats
Bookmark the HC3 webpage for quick access to federal guidance. With the rise of telehea... Read more
Don’t Let New Tech Introduce New Cyber Threats
Bookmark the HC3 webpage for quick access to federal guidance. With the rise of telehea... Read more
Reader Questions:
Consider the Codes for Preventative Fluoride Varnish Application
Question: My provider is considering offering fluoride varnish applications preventat... Read more
Consider the Codes for Preventative Fluoride Varnish Application
Question: My provider is considering offering fluoride varnish applications preventat... Read more
Reader Questions:
Check for Additional Details When Reporting Persistent Asthma
Question: My pediatrician documented that the patient has persistent asthma. Does tha... Read more
Check for Additional Details When Reporting Persistent Asthma
Question: My pediatrician documented that the patient has persistent asthma. Does tha... Read more
Reader Questions:
Rely on Documentation to Support MDM Level
Question: Does an undiagnosed new problem with uncertain diagnosis automatically mea... Read more
Rely on Documentation to Support MDM Level
Question: Does an undiagnosed new problem with uncertain diagnosis automatically mea... Read more
You Be the Coder:
Heed This Peds Transition Coding Advice
Question: Our pediatrician has several patients who are about to transition from pedi... Read more
Heed This Peds Transition Coding Advice
Question: Our pediatrician has several patients who are about to transition from pedi... Read more
Modifiers:
Reduce Your Confusion Around Modifiers 52 and 53
Also: know which one could even apply to a wastage situation. As you know, modifiers are ... Read more
Reduce Your Confusion Around Modifiers 52 and 53
Also: know which one could even apply to a wastage situation. As you know, modifiers are ... Read more
E/M Coding:
Check These 3 Scenarios to See if You’re an MDM Master
Also: see what one MAC says about prescription drug management. While calculating levels... Read more
Check These 3 Scenarios to See if You’re an MDM Master
Also: see what one MAC says about prescription drug management. While calculating levels... Read more
Practice Management:
Answer These FAQs to Stay On the Right Side of the Rulebook
Find insight into free samples. Sometimes, HIPAA and code of conduct (COC) rules and re... Read more
Answer These FAQs to Stay On the Right Side of the Rulebook
Find insight into free samples. Sometimes, HIPAA and code of conduct (COC) rules and re... Read more
Reader Questions:
Properly Sequence This Multiple-Diagnosis Encounter
Question: Our pediatrician recently diagnosed a patient with bronchopneumonia and inf... Read more
Properly Sequence This Multiple-Diagnosis Encounter
Question: Our pediatrician recently diagnosed a patient with bronchopneumonia and inf... Read more
Reader Questions:
Pick the Correct Code for This STD Testing Encounter
Question: If a provider tests a patient for a sexually transmitted disease (STD), but... Read more
Pick the Correct Code for This STD Testing Encounter
Question: If a provider tests a patient for a sexually transmitted disease (STD), but... Read more
Reader Questions:
Know How to Justify Modifier 25 For Minor Procedure Encounters
Question: Should I always append modifier 25 for a minor procedure with an evaluatio... Read more
Know How to Justify Modifier 25 For Minor Procedure Encounters
Question: Should I always append modifier 25 for a minor procedure with an evaluatio... Read more
You Be the Coder:
Can You Code This Critical Care Transition?
Question: Our hospital physician provided a neonate with critical care throughout the... Read more
Can You Code This Critical Care Transition?
Question: Our hospital physician provided a neonate with critical care throughout the... Read more
Condition Spotlight:
Stay Awake for This Sleep Disturbance Code Guide
Also: refresh your memory of the 2023 sleep apnea codes. From simple nightmares to more s... Read more
Stay Awake for This Sleep Disturbance Code Guide
Also: refresh your memory of the 2023 sleep apnea codes. From simple nightmares to more s... Read more
Modifiers:
Modify Your Understanding of Reporting Wastage with JZ and JW
Also: Use this clinical example to help you calculate wastage. On Jan. 1, 2023, Medicar... Read more
Modify Your Understanding of Reporting Wastage with JZ and JW
Also: Use this clinical example to help you calculate wastage. On Jan. 1, 2023, Medicar... Read more
Practice Management:
Improve Your CDI Process With This Expert Advice
Also: understand how to identify the need for a query. Quality patient care, accurate r... Read more
Improve Your CDI Process With This Expert Advice
Also: understand how to identify the need for a query. Quality patient care, accurate r... Read more
Reader Questions:
Be Positive When Reporting Official Diagnoses
Question: We have a patient with a cough who is RSV positive. What ICD-10 code or co... Read more
Be Positive When Reporting Official Diagnoses
Question: We have a patient with a cough who is RSV positive. What ICD-10 code or co... Read more
Reader Questions:
Make Time to Understand the New Time-Based E/M Descriptors
Question: We have a provider who wants to bill based on time, but they only spent 8 m... Read more
Make Time to Understand the New Time-Based E/M Descriptors
Question: We have a provider who wants to bill based on time, but they only spent 8 m... Read more
Reader Questions:
Check for These Codes When Reporting Yeast Infections
Question: I've been using B37.3 to report yeast infections, but the last claim I subm... Read more
Check for These Codes When Reporting Yeast Infections
Question: I've been using B37.3 to report yeast infections, but the last claim I subm... Read more
You Be the Coder:
Keep Your Eye on This Neonatal Conjunctivitis Case
Question: Our pediatrician recently diagnosed a 10-day old patient with bacterial con... Read more
Keep Your Eye on This Neonatal Conjunctivitis Case
Question: Our pediatrician recently diagnosed a 10-day old patient with bacterial con... Read more
Final Rule:
Know What’s What Within the MPFS Final Rule
Find detailed information about the split/shared policy update. In Pediatric Coding Alert... Read more
Know What’s What Within the MPFS Final Rule
Find detailed information about the split/shared policy update. In Pediatric Coding Alert... Read more
Case Study Corner:
Break Free From Fear of Fracture Care Coding
Know when to code buddy tape separately. Kids are great at having fun, but they're also g... Read more
Break Free From Fear of Fracture Care Coding
Know when to code buddy tape separately. Kids are great at having fun, but they're also g... Read more
Mythbusters:
Bust These Myths for Accurate Ear Condition Coding
Hear the difference between otalgia and otitis media. Pediatric conditions related to the... Read more
Bust These Myths for Accurate Ear Condition Coding
Hear the difference between otalgia and otitis media. Pediatric conditions related to the... Read more
Reader Question:
Flex Your Coding Muscles with This Charley-Horse Case
Question: The pediatrician documents that a patient had a charley-horse. Which code i... Read more
Flex Your Coding Muscles with This Charley-Horse Case
Question: The pediatrician documents that a patient had a charley-horse. Which code i... Read more
Reader Question:
Defer to Payer Interpretation When Reporting Interpreter Code
Question: What are the guidelines for T1013? We have an in-house certified interprete... Read more
Defer to Payer Interpretation When Reporting Interpreter Code
Question: What are the guidelines for T1013? We have an in-house certified interprete... Read more
Reader Question:
Locate the Correct Codes for This Dislocation Encounter
Question: A 4-year-old boy presented with a dislocated right elbow. After examination... Read more
Locate the Correct Codes for This Dislocation Encounter
Question: A 4-year-old boy presented with a dislocated right elbow. After examination... Read more
You Be the Coder:
Remember These Points When Reporting E/M with UA Code
Question: For all lab tests performed in the office, our nurse researches the history... Read more
Remember These Points When Reporting E/M with UA Code
Question: For all lab tests performed in the office, our nurse researches the history... Read more
Pediatric Coding:
To Bill E/M, Exam Must Go Above and Beyond
Question: I work at a pediatrician's office and had an encounter where a patient came in f... Read more
To Bill E/M, Exam Must Go Above and Beyond
Question: I work at a pediatrician's office and had an encounter where a patient came in f... Read more
Pediatric Coding:
Differentiate Between Child and Adult BMI Calculations
Question: Can I use the equation for calculating adult body mass index (BMI) — (weight i... Read more
Differentiate Between Child and Adult BMI Calculations
Question: Can I use the equation for calculating adult body mass index (BMI) — (weight i... Read more
Pediatric Coding:
Nail Down Strep Pharyngitis Coding
Prepare now for a possible uptick in visits for streptococcal pharyngitis and tonsillitis.... Read more
Nail Down Strep Pharyngitis Coding
Prepare now for a possible uptick in visits for streptococcal pharyngitis and tonsillitis.... Read more
Pediatric Coding:
Check With Payer to See When Age Matters
Question: I work at a pediatrician's office that sees some older children whose encou... Read more
Check With Payer to See When Age Matters
Question: I work at a pediatrician's office that sees some older children whose encou... Read more