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Pediatric Coding Alert

Pediatricians Can Take Advantage of 2001 CPT Changes to Increase Payments
Although there arent many major changes for pediatricians in CPT Codes 2001, there are a... Read more
New and Revised CPT 2001 Vaccine Codes
New vaccines and vaccine combinations are being developed at a fast and furious pace. Code... Read more
Gain Reimbursement by Proper Use of After-hours Code
The after-hours codes (99050-99054) can help pediatricians increase their reimbursement ... Read more
Use of Critical Care Codes Sharply Restricted for 2001
Critical care services (99291, critical care, evaluation and management of the criticall... Read more
Correction:
Emergency Visits
The November 2000 Pediatric Coding Alert contained a typographical error in the reader que... Read more
Reader Question:
-QW Modifier
Question: When and how should we use the -QW modifier for lab tests? Our lab does provider... Read more
Reader Question:
Allergy Diagnosis Coding
Question: How should we code the diagnosis for allergy shots? We provide the shot only; th... Read more
Reader Question:
Neonatal Critical Care
Question: A baby developed problems several days after birth. The pediatrician transferred... Read more
Reader Question:
Hearing Exam With Physical
Question: Parents often bring their child in for a physical and want their childs hearing ... Read more
Reader Question:
Diabetic Ketoacidosis
Question: What is the proper way to bill for diabetic ketoacidosis?Wisconsin Subscriber An... Read more
You Be the Coder:
Newborn Checkup
Question: Should we charge a new or established evaluation and management (E/M) code whe... Read more
Code Diabetes Cases for Maximum Ethical Reimbursement
When pediatric patients have diabetes, they have special needs that make the entire coding... Read more
Use RBRVS to Set Your Fees
If you have already converted your practice fee schedule to one based on the resource-base... Read more
Gain Proper Payment for Hearing Screening and Testing
Pediatricians are under pressure to screen their patients for hearing problems, but do n... Read more
Reader Question:
Missing Pectoralis Major Muscle
Question: How do I code for the congenital absence of the pectoralis major muscle? Ca... Read more
Reader Question:
New Vaccine Code
Question: We just received information regarding a new vaccine product code, CPT 90723 , f... Read more
Reader Question:
Assessing Newborns
Question: If a baby is born on Sept. 6 and assessed and discharged on Sept. 7, should we b... Read more
Reader Question:
Emergency Visits
Question: What codes are used at a pediatricians office for emergency visits? For vision s... Read more
You Be the Coder:
Botox Treatment
Question: Are there clear and defined diagnoses that would apply to botox treatments for p... Read more
Six Steps to Optimize Reimbursement for an Asthma Crisis
Pediatricians can spend several hours treating a patient for an asthma attack a challenge... Read more
Hot Coding Tip of the Month:
Use Modifier -25 for Well Visits And Office Visits
Speaking to the medical director of your managed-care company will help you get paid for a... Read more
Coding in the News:
Unit Edit on 90472 May Be Fixed Soon
The Health Care Financing Administration (HCFA) implemented a unit edit on code 90472 (imm... Read more
Correction:
Code 94640, Not 94960, for Nebulizers
In the September 2000 issue of Pediatric Coding Alert, the article Get Proper Reimbursemen... Read more
Reader Question:
Mantoux Test
Question: Can we bill for the administration of vaccine (90741) with a Mantoux test (CPT 8... Read more
Reader Question:
Preoperative Exam
Question: What is the best way to code for preoperative exams?Connecticut Subscriber Answe... Read more
Reader Question:
Ear Piercing Infection
Question: How do you code for infection of an ear lobe due to ear piercing?New York Subscr... Read more
Reader Question:
Drug Withdrawal Syndrome
Question: A mother brought in her newborn and claimed she used cocaine while pregnant. Wha... Read more
Reader Question:
After-hours Care
Question: We have evening hours from 5 to 8 p.m. on weekdays, and weekend morning hours fr... Read more
Reader Question:
7-Valent Pneumococcal Vaccine
Question: What code should be used for the new 7-valent pneumococcal vaccine? Is CPT 90732... Read more
Reader Question:
Newborn Resuscitation
Question: A neonatologist is called into the delivery room for a consult on a newborn, and... Read more
You Be the Coder:
Premature Baby
Question: Our doctors admitted a newborn baby who was premature and had respiratory distre... Read more
Get Proper Reimbursement for Multiple Nebulizer Treatments
Pediatricians are still confused about how to bill for multiple nebulizer treatments and t... Read more
Get Paid for Lactation Counseling
Now, there is no CPT code for providing lactation counseling. So, how can pediatricians ... Read more
Hot Billing Tip of the Month:
How One Practice Deals With Prescriptions
Pediatricians and their staff are spending more and more time on the phone calling in pr... Read more
Fight Downcoding by Payers With Thorough Documentation
When the Health Care Financing Administration (HCFA) announced last spring that it would s... Read more
News Brief:
AAP Issues Precertification Recommendations
Pediatricians are well aware of how frustrating it can be to refer a patient to a speciali... Read more
Reader Question:
Newborn Care
Question: What is the correct way to bill for newborn care in the hospital to ensure the h... Read more
Reader Question:
Physicals
Question: We are using CPT 99420 (administration and interpretation of health risk assess... Read more
Reader Question:
Allergy Shot
Question: When a patient comes into our office just for an allergy injection that is given... Read more
Reader Question:
Preventive Visit
Question: In reference to billing a preventive visit for a physical with an office visit a... Read more
Reader Question:
Additional Service
Question: When a problem is discovered during a well-child visit, the -25 modifier goes on... Read more
You Be the Coder:
Blood Draw
Test your coding knowledge. Determine how you would code this situation before looking at... Read more
Avoid Audits:
Proceed With Caution When Billing 99211 and Immunization Administration Codes Together
While it is technically correct coding to bill 99211 (office or other outpatient visit for... Read more
Compliance Alert:
Top Documentation Coding Errors
by Thomas Kent, CMM, CPC, is principal of Kent Medical Management, a coding and practice m... Read more
The Point System and Medical Decision-Making
The point system is used in scoring medical decision-making, one of the three key factors ... Read more
Get Paid For Prevnar and Future Vaccines
Many pediatricians and office managers believe the recommendations for the use of Prevna... Read more
Reader Question:
Fussy Child
Question: Can you suggest a suitable code to use for a fussy, irritable child with no spec... Read more
Reader Question:
Chronic Conditions
Question: Generally I see a child before referring him/her. But if the patient has a chron... Read more
Reader Question:
Newborn Exam
Question: If a baby is brought into the doctors office for an exam two or three days after... Read more
Reader Question:
Physical and Shots
Question: We had a patient today who needed a complete physical and shots for kindergarten... Read more
Reader Question:
Suture Removal
Question: How do we bill for removal of sutures placed elsewhere? The child has had sutu... Read more
You Be the Coder:
Outpatient Therapy
Test your coding knowledge. Determine how you would code this situation before looking at... Read more
Newborn Care:
Get Reimbursed for Initial Visit Face-to-Face Only
Pediatricians often give advice over the telephone when a baby is born after they have don... Read more
Avoid Fraud Charges by Following OIG Guidelines
To avoid fraud and abuse charges, pediatric practices should follow the recently release... Read more
Pont of View:
Hot Coding Tips, Part 2
By A.D. Jacobson, MD, FAAP Chairman of the American Academy of Pediatrics (AAP) section on... Read more
News Brief:
AMA Releases New Vaccine Product Codes Early
The American Medical Association (AMA) has released 10 new vaccine codes six revised, an... Read more
Reader Question:
Charging for Forms
Question: Our 16-physician pediatric practice completes a lot of forms for parents. Is the... Read more
Reader Question:
Newborn Visit and Hepatitis Shot
Question: When billing initial newborn visit and hepatitis shot, how can we get paid for ... Read more
Reader Question:
Attendance at Delivery
Question: How many base units can we charge for CPT Code 99436? Minnesota Subscriber ... Read more
You Be the Coder:
Dorsal Slit
Test your coding knowledge. Determine how you would code this situation before looking at... Read more
One Pediatrician's Experience:
Get Reimbursed for Well Visit and Office Visit With Modifier -25
When a child is in for a well visit and also has a problem that the pediatrician knows jus... Read more
Optimize Pay for Office Visits When Diagnosis is Vague
Pediatricians are familiar with unnecessary appointments. The mother is so worried about h... Read more
Top 10 Coding Tips Revealed
By A.D. Jacobson, MD, FAAPThis months columnist, A.D. Jacobson, MD, FAAP, is chairman of t... Read more
News Brief:
AAP Releases New Guidelines To Help Diagnose ADHD
In the wake of the Clinton administrations assertion that behavioral medications, such as ... Read more
Reader Question:
Minor Procedures
Question: We do some minor procedures here in our office, such as 16000 (initial treatment... Read more
Reader Question:
Supplies and Materials
Question: We are having difficulty getting some CPT Codes paid by insurance companies. ... Read more
Reader Question:
Preventive Visits
Question: We recently have had portions of our claims denied. A child is seen for a one-ye... Read more
You Be the Coder:
Disposable Skin Stapler
Test your coding knowledge. Determine how you would code this situation before looking a... Read more
Optimize Post-op Pay by Using Diagnoses Codes That Are Different From Surgeons
For proper reimbursement, pediatricians administering post-op care should use a different ... Read more
Get Reimbursed for Suspected Munchausen by Proxy
Pediatricians, not sure if they are faced with Munchausen by Proxy (MBP) syndrome, should ... Read more
Follow Up:
Get Paid for Nebulizer Encounters
In the April 2000 issue of Pediatric Coding Alert, we covered the difference between 946... Read more
Point of View:
Understanding the New Vaccine Administration Codes
by Joel Bradley, MD, FAAP This months columnist, Joel Bradley, MD, FAAP, is chief of ... Read more
Reader Question:
Adoption Advice
Question: The mother of an established patient wants to adopt a 16-month-old baby from a f... Read more
Reader Question:
Transfers
Question: What is the correct way to bill when a child transfers from different units, say... Read more
Reader Question:
Varivax Shot
Question:,/B> I billed a Varivax shot (90716) for $63, and the insurance company paid only... Read more
Reader Question:
Attendance at Delivery
Question: The pediatrician attends delivery (99436) for meconium staining, and there is th... Read more
Reader Question:
Insurance Co-pays
Question: When a patient is asked to pay a co-pay and cannot pay now for whatever reason, ... Read more
Reader Question:
Dermabond
Question: We use Dermabond for some suture jobs. How do we code this? Is there any change ... Read more
Reader Question:
Newborn Circumcision
Question: When a pediatrician performs a newborn circumcision and uses a penile block, is ... Read more
You Be the Coder:
Follow-up Visits
Test your coding knowledge. Determine how you would code this situation before looking at... Read more
Optimize Reimbursement for Nebulizer Encounters With Proper Coding
Pediatricians are often confused about whether to code 94640 (nonpressurized inhalation t... Read more
Get Reimbursed for Your Time For Nebulizer Treatments
When coding for nebulizer encounters, how do you factor in the time the pediatrician spend... Read more
Get Paid for Violence Prevention Screening
Pediatricians can use counseling codes (99401-99404, 99411-99412) to talk to children and ... Read more
News Brief:
Vaccine Administration Bundling Narrowly Averted
Pediatricians need to keep an eye on payers to make sure they heed CPT when it comes to ... Read more
Point of View:
How to Fight Back Against Managed Care
This months columnist, Charles Scott, MD, FAAP, is vice president-elect of the New Jersey ... Read more
Reader Question:
Hospital Intensivist
Question: How would you bill for a hospital intensivist who handles a critical patient bro... Read more
Reader Question:
Home Visits
Question: Our pediatricians are thinking about seeing newborns at one week at the babys ho... Read more
Reader Question:
Normal Exam
Question: What is the proper coding of a visit when a child is brought in to see the docto... Read more
Reader Question:
High-risk Birth
Question: When our neonatologist is called in for a prenatal consultation on a high-risk b... Read more
You Be the Coder:
Student Visits
Test your coding knowledge. Determine how you would code this situation before looking a... Read more
Optimize Reimbursement for ADHD
Correctly coding for the diagnosis, the evaluation visit and follow-up visits is crucial t... Read more
Get Paid for Vision Screening Using the New Code
To optimize reimbursement for vision screening, pediatric practices need to understand w... Read more
Field Loses Coding Expert and Good Friend
On Jan. 28, Charles M. Vanchiere, MD, FAAP, a founding member of the Editorial Advisory Bo... Read more
Point of View:
Enhance Your Revenue by Reviewing 10 Key Procedures
This months column is by Richard H. Tuck, MD, FAAP, a member of the American Academy of Pe... Read more
Reader Question:
Well Visits vs. Sick Visits
Question: If a child comes in for a well visit and it turns out that the child is sickfor ... Read more
Reader Question:
Urinalysis
Question: Most insurance plans are refusing to pay for a urinalysis (CPT 81002 ) along wit... Read more
Reader Question:
Oxygen
Question: How do you bill for a patient who gets oxygen in the office? The HCPCS Codes p... Read more
Reader Question:
Newborn Code
Question: I am having problems with the newborn code 99431 and the resuscitation code 9944... Read more
You Be the Coder:
Administration Codes
Test your coding knowledge. Determine how you would code this situation before looking at... Read more
Correctly Code Immunization-Only Visits with 90471/90472, Not Nurse Only Visits
When a child cannot be immunized during a well visit, perhaps because of an infection, and... Read more
Fight for Reimbursement of 90471/90472
If you are having a hard time getting paid for 90471/90472, you have to fight for it, says... Read more
Improve Reimbursement For Office Visits with Bell Curve
Pediatricians often undercode and undervalue their services, says Richard H. Tuck, MD, FAA... Read more
Coding Tip of the Month:
Increase Reimbursements by Reviewing EOBs
When Linda Walsh, MAB, the new senior health policy analyst at the American Academy of Ped... Read more
Reader Question:
Adolescent Patients
Question: I am providing both preventive healthcare as a physical and preventive gyn/contr... Read more
Reader Question:
Courtesy Visits
Question: As a primary-care pediatric office, we like to stop in and see our patients and ... Read more
You Be the Coder:
INH Therapy
Test your coding knowledge. Determine how you would code this situation before looking at... Read more
Optimal Coding for Sick Visits When the Child Isnt Sick
Pediatricians are all too familiar with the syndrome: The worried parent, especially the n... Read more
Billing Visits for Fetal Anomalies
Pediatrics and obstetrics are by necessity closely intertwined at times, making coding a... Read more
Pulse Oximetry No Longer Paid by Medicare
As of this month, Medicare will no longer pay for pulse oximetry (94760, 94761, 94762) b... Read more
How to Fight the Bundling of Immunization Codes
CPT Codes 2000 solved the vexing problem of 90472 (its no longer for administering two ... Read more
Conscious Sedation:
Getting the Code Paid
The conscious sedation codes (99141 for intravenous, intramuscular, or inhalation and 9914... Read more
You Be the Coder:
Attempted Resuscitation
Test your coding knowledge. Determine how you would code this situation before looking at... Read more
Available Years:  2000  1999  1998