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Pediatric Coding Alert
Pediatric Coding Alert
Pediatric Coding Alert - 2008; Volume 11, Number 12
CPT 2009:
4 Pointers Help You Find Relocated Newborn, Pediatric Care Codes
Your days of flipping through unrelated pages are over.You'll have an easier time putting ...
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Revision May Spell 'Relief' for 99440 Denials
New resuscitation code stresses separate site.If your neonatal group is plagued with newbo...
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Weigh Dollars Vaccine, Tobacco Counseling Options Can Deliver
Let condition, coverage steer selection.Before you write off time you spend providing smok...
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Avoid Negative 90772 Attention
This action plan will make your Rocephin, Decadron claims shine.Although therapeutic injec...
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Reader Question:
This Modifier Isn't a Helping Tool
Question: When the same physician gives multiple vaccines at the same encounter, should I ...
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Reader Question:
Meet 3 R's to Boost Pre-Op Pay
Question: A surgeon asked a pediatrician for pre-op anesthesia clearance on a new patient....
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Reader Question:
Versus' Dxs Require Follow Up
Question: In an outpatient physician setting, the pediatrician wrote only "URI vs. Pneumon...
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Reader Question:
99444 Requires Numerous Criteria
Question: Does an Internet office visit trigger a copay?Ohio SubscriberAnswer: Using 99444...
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Reader Question:
Include This Info in ROS Update
Question: A pediatrician sees a patient for a problem two weeks after previously treating ...
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Reader Question:
Report 87804 Per Result
Question: Our office has been billing 87804 (flu testing) as a quantity of 1 until recentl...
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You Be the Coder:
Make $50 More for Hematoma I&D
Question: I spent a while poking at a patient's blood clot to get it to break. I put on pr...
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Pediatric Coding Alert - 2008; Volume 11, Number 11
Try 4 Strategies to Score 100 on Sports Physical
Parents can choose covered annual or self-pay exam.If you're at a loss for how to code a s...
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Bust the AM, PM Nebulizer Treatment, Training Myth
You'll rethink 94640, 94664-59 thanks to these experts' explanations.Misinterpreting modif...
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Before Coding 94664, Check Off These Items
Chart must show training's medical necessity to make appeal worthwhile.You can challenge t...
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Circle 'Moderate' When MD Weighs Medication Risk
Giving samples involves same process -- just without paper.You might not be giving yo...
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Factor Elements, Components + Med Management to Check E/M
You should consider risk only a part of level selection.Your pediatrician's level won't ho...
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Pros, Cons of Same Day E/Ms
Question: Does reporting an established patient preventive medicine service and a problem-...
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Get Payers to Up Consult Pay
Question: An insurer is paying us less for consultations than established patient office v...
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Troubleshoot Wart Removal Denial
Question: I received a denial from Medicaid for 99214-25, 078.19, and 17110. The carrier...
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READER QUESTIONS:
ICD-9 Code for 'Gross Motor Delay'
Question: A pediatrician I code for writes "gross motor delay." Unfortunately, her office ...
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Pediatric Coding Alert - 2008; Volume 11; Number 10
Put Your 99477 Payment on the Proper Path By Sticking to These Guidelines
Newborn post-day-1 claims should contain subsequent intensive care, not initialYou've got ...
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Realize Day 1 Can Contain 99431-25, 99477
Code 99477 can be second E/M on initial dayIf a normal newborn becomes sick on day one fol...
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Get the Inside Scoop on Selecting Time-Based E/M
Guideline determines if minimum, average appliesThink 35 minutes spent on a counseling-dom...
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Ease Well-Visit Coding With V20.2 Across the Board
Beware: Payers may force you to use 'acceptable' dxIf you've been struggling with when to ...
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READER QUESTIONS:
Two Hospital Visits: 1 E/M or 2?
Question: A private payer representative informed my doctors that they can bill for more...
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Reader Questions:
Is There an Attempted Procedure Modifier?
Question: When a certified medical assistant (CMA) performs a screening and cannot get a r...
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Reader Questions:
Charge Adoption Evaluation to Parent/PPO
Question: We have a pediatrician who specializes in international adoptions. When a family...
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Reader Questions:
Connect Saturday Code to Hours, Not Dx
Question: Our office is open on Saturdays. What ICD-9 codes would the claim require to use...
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You Be the Coder:
Strep Bundle Signals Larger Problem
Question: Our pediatric office is using 86403 for rapid strep tests and receiving denials ...
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Pediatric Coding Alert - 2008; Volume 11, Number 9
Break Down Fracture Care to Get Paid for Your Piece of the Pie
These 4 real-life scenarios test your globalization versus itemization skillsJust because ...
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Stop Postop Fracture Care Double Dips With Inside Tips
You've got to teach your ED/clinic to sharePutting modifier 55 on fracture care codes can ...
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ICD-9 Update:
Change Plantaris Wart Code for Specific ID
Pediatric expert shows you the diagnoses to add to your superbillYou'll add only the diagn...
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Cautionary Tale:
Protect Time-Based Pay in 2 Easy, But Critical, Steps
Omitting this detail could cut a 99214 to a 99213If time-selected E/M documentation does n...
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READER QUESTIONS:
Do These Calls Fall Within 99441-99443?
Question: A parent leaves a message seven days after the previous related E/M and wants ph...
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Reader Questions:
Is Consult + Circ OK?
Question: Other pediatricians who do not perform circumcisions ask me to do the circumcisi...
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Reader Questions:
Treat Clinic As Office for Supervision
Question: I work in a clinic located in a hospital building. Can a nurse run an allergy sh...
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Reader Questions:
Do Dual Notes Require PE Reentry?
Question: On an electronic medical record (EMR), do I need to redocument the physical exam...
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You Be the Coder:
Check Location Before Coding ECG
Question: After obtaining a patient and family health history and doing a physical exam fo...
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Pediatric Coding Alert - 2008; Volume 11, Number 8
ICD-9 Update:
Prepare to Expand Fever Diagnosis So Fall Claims Will Sail Through With Ease
Your 780.6 entry will soon require four more linesTo report a fever of unknown origin (FUO...
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Protect Incident-to NPP Pay With Added Phrase
Your NP can report service directly without satisfying criteriaYour pediatricians won't ha...
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Stop Hunting for HPI Rule With Inside Info
The AMA considers this element your pediatrician's dutyAlthough support staff might want t...
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Reader Questions:
Multiple Screens: 1 Code or 2
Question: A pediatrician performs two 96110s -- a PEDS and an ASAS. Can I report 96110 mul...
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Reader Questions:
Audit Quiz: How Many HPI in 'Dull Ache'?
Question: I'm auditing a note that states:"CC: A patient seen in the office complains of l...
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Reader Questions:
Include Spirometries in 94060
Question: We are looking into buying a digital spirometer. What is the difference between ...
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Reader Questions:
Tally 30+ Indirect Minutes for 99358-99359
Question: Through negotiations, some payers have agreed to cover non-face-to-face services...
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Reader Questions:
Check Hand or Foot Before Coding FBR
Question: Using a needle to make an incision, a pediatrician removed a wood splinter from ...
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Reader Questions:
Recoup Refused Vaccine Counseling
Question: We're spending a lot of time counseling parents on the importance of receiving i...
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You Be the Coder:
Include Anesthesia in 1 Circ Type
Question: When a pediatrician performs a neonatal circumcision without anesthesia, a consu...
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Pediatric Coding Alert - 2008; Volume 11, Number 7
Report Reinstated Albuterol, Levalbuterol Codes to Avoid Denials
Payers are already accepting 'new' HCPCS 2008 J codesIf you're after a nebulization treatm...
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Check 4 Items Before Coding Inhalation Solution
Don't use J7611-J7614 if you mix med or use sampleAlthough albuterol and levalbuterol J co...
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Collect on Counseling, Calls by Using Waiver Basics
Modifier GA flags 99442 as patient's responsibilityAlleviating write-offs for noncovered, ...
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Reader Questions:
Avoid Routine Pap Carve Out With Prep
Question: Many of our female teenage patients prefer to return to see our female pediatric...
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Reader Questions:
Exam Interpretation Vs Bean-Counting
Question: Would our general pediatric practice benefit more from using the 1995 or the 199...
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Reader Questions:
How to Code Admit to Hospitalist
Question: A pediatrician sees an established patient in the office for high fever and dehy...
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Reader Questions:
Count the Note's Components for E/M
Question: I'm auditing a note that reads: "12-yr-old with new prob. Pharyngitis." There's ...
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Reader Questions:
Anticipate Nursemaid Elbow Diagnoses Next Fall
Question: A child required reduction of a subluxed radial head. Is there a specific ...
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You Be the Coder:
Counseling for Obese Children
Question: Insurers aren't paying 99408-99409 (behavior change intervention) for a nutritio...
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Pediatric Coding Alert - 2008; Volume 11, Number 6
Avoid 99173 Bundles by Offering Readily Paid VEP Vision Testing
This amblyopia screening tool has its own codeIf you want to test nonverbal patients for v...
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Get Paid for 95930 During E/M Using 2 ICD-9 Tips
Watch out: Sometimes a well-check diagnosis isn't the way to go You'll get pai...
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Case Study:
Try 4 Strategies to Deter 90472 Duplication Denials
These forms reveal legit multiple-IA billing methodsWhen faced with rejections for multipl...
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Reader Questions:
Should We Apply CCI Across the Board?
Question: We are a large multispecialty group. Some coders who file Medicare claims sugges...
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Reader Questions:
How to Make a Time Note Audit-Friendly
Question: When coding based on time, my pediatricians document the amount of time they spe...
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Reader Questions:
Antibiotic Points to But Doesn't Cinch 99214
Question: The risk management table lists prescription drug management as moderate risk. D...
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Reader Questions:
Treat Special Service Codes as Add-Ons
Question: Do we need to use a modifier when coding prolonged services or special service...
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Reader Questions:
Article Provides Ammo for 9944x Coverage
Question: A pediatrician talked to a mom who called in because her toddler's gum was stuck...
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You Be the Coder:
E/M or Nosebleed Code?
Question: A mother brought in her teenage son who had collided with another player in a so...
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Pediatric Coding Alert - 2008; Volume 11, Number 5
Prevent Payment Loss on 90760, 90772 With This Bundle-Breaking Tool
CCI 14.1 forces you to get a handle on separate, significant serviceThe next time a patien...
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Expert Advice:
Ask 4 Questions to Spot Significant, Separate Service
Clip and save your modifier 25 use checklistEasily distinguish a significantly separate E/...
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CCI 14.1 Update:
Limit Nebulizer Treatment to 94640 or 94644
3 must-have edits prepare you for strapping, nebulizer, ECG denials & moreFind out whe...
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Advanced Lesson:
Restrict 99366, 99368 to Non-MD NPI Holders
Incident-to creates off-site hang-upsDon't let your staff attend school conferences unless...
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Reader Questions:
Prepare for 'UHC Meets CCI'
Question: I've heard that I'm going to have to start changing some of the codes that I bil...
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Reader Questions:
Reduce Consult Faxes by Striking First
Question: Specialists keep faxing our office consultation confirmation forms for us to com...
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Reader Questions:
Consider Flu Nasal-Wash Options
Question: Is there an appropriate "collection code" to report for performing the flu nasal...
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Reader Questions:
Will Law Portend Better 314.0x Coverage?
Question: I've read about the possible legislation that would disallow insurers from discr...
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Reader Questions:
How to Report Hearing Loss Unfounded
Question: A patient comes to us after failing a school hearing screen but passes our in-of...
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You Be the Coder:
Could Sepsis Care Fall Under 99477?
Question: A pediatrician cannot determine a newborn's gender. The physician contacts an en...
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Pediatric Coding Alert - 2008; Volume 11, Number 4
Capture All 'Bright Futures' Services Using This Step-by-Step Guide
Well checks involve many extras -- which one are you forgetting to code?If you're not clea...
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Must-Have Chart:
Leave No Ancillary Service Unclaimed With This Bright Futures-CPT Crosswalk
Post your one-stop shop for well-check-related codesStop missing one or two codeable preve...
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Charge Allowed Inhalation Services With Coding Do's
Code 94664 specifies 4 devices -- but that's not the be-all listStop missing opportunities...
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Reader Questions:
E/M Is Best Bet for Suture Removal
Question: For suture removal, may I refer the patient to the facility that placed the stit...
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Reader Questions:
Squirmy Child Stops Screen
Question: We tried to do an audiogram with a patient, but we were unable to obtain it. Isn...
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Reader Questions:
Which E Code Goes First?
Question: A patient suffered a second-degree burn on his forearm due to his angry father p...
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Reader Questions:
Learn 2008 Conversion Factor -- for Now
Question:What is the conversion factor for 2008?North Carolina SubscriberAnswer: The conve...
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Reader Questions:
Code Initial Care at 1st Inpatient Visit
Question: A pediatrician admits a patient to observation on Feb. 22. The physician writes ...
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Reader Questions:
Zoom In on Fluorescein Use
Question: Our pediatrician performed a fluorescein staining for detecting a corneal abrasi...
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You Be the Coder:
Tally Cough, Cold, Wheezing History Note
Question: A pediatrician documents, "12-month-old here for evaluation of cough and cold sy...
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Pediatric Coding Alert - 2008; Volume 11, Number 3
Case Study:
Limit Lead Poisoning Diagnosis to Positive Test -- or Risk Fraud Charges
Better way: A high-risk V code can remedy payment woesYou're going to have to use an extra...
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Paint a Rosier Financial Picture With 3 Fresh Tips
This practice was losing $32 per chest x-ray -- but not anymoreKeeping your practice from ...
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Steer Clear of Screening and Well-Check Modifier Mishap
Modifier 25 is the way to go with E/MsYou may no longer have the option of using modifier ...
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Reader Questions:
Can You Bill for Parents-Only Conference?
Question: An established patient's parents came in without their teenage son to discuss hi...
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Reader Questions:
Clip and Save Your 99477 Bundle List
Question: What services are included in the new neonatal initial hospital intensive care c...
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Reader Questions:
Avoid 99211 for MD Weight Loss Evaluation
Question: A mother brought an infant in three days after a hospital delivery for a nurse...
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Reader Questions:
Which Codes Are Missing From CPT 2008?
Question: I read that the CPT 2008 manual doesn't contain three new vaccine codes. Would y...
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You Be the Coder:
Do Butterfly Bandages = Repair Code?
Question: A mother brings her 10-year-old daughter to our office because the child fell fr...
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Pediatric Coding Alert - 2008; Volume 11, Number 2
Obtain Elusive Screening Payment With These Methods
Which item is your well-check inclusion appeal pack missing?Before you throw in the towel ...
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Avoid Using 'Loophole' to Bill Routine OMs as 99214s
Surprise! CPT and CMS require medical necessity for all E/M visitsIf you fall for the "E/M...
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Clarification:
Check Law Before Extending Traditional MD-Only Codes
CPT doesn't offer the final word The Reader Question "NPs Can Use MD Codes" in Pediatric C...
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READER QUESTIONS:
Stick With 075 for EBV
Question: Should I code Epstein-Barr with new 2008 code 058.89 (Other human herpesvirus in...
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READER QUESTIONS:
Photoscreening Gets Category I Code
Question: I'm questioning our practice's use of 92015 for photoscreening. The procedure do...
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READER QUESTIONS:
Keep Coding When $$$ Don't Roll In
Question: When an insurance carrier does not pay for a code, should we still report it?Vir...
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READER QUESTIONS:
3 Ways to Code Suture Removal
Question: For suture removal, we found 15851. When a pediatrician removes sutures in the o...
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READER QUESTIONS:
Are Consult Requests Limited to MDs?
Question: A school nurse or teacher asks a pediatrician for an opinion on a child, and the...
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READER QUESTIONS:
Does 90634 + 90471 Require 51?
Question: Can you settle a dispute our office is having? Do we need to use modifier 51 whe...
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READER QUESTIONS:
Update Hospital Bladder Aspiration Code
Question: A pediatrician performs a suprapubic aspiration to obtain a clean urine specimen...
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You Be the Coder:
Code Tooth Decay Preventive Service
Question: Our pediatricians are considering offering in-office fluoride treatments as an a...
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Pediatric Coding Alert - 2008; Volume 11, Number 1
Get These Facts Before Buying SureSight for Vision Screening
u Caution: Product info could misdirect you to 92015 If you're considering replacing tech...
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Ask 2 Questions Before Coding Chronic Condition
u Asthma scenario tests your dxs ordering skills A patient with asthma or diabetes always...
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CPT Update:
Capture Care Beyond 99223 With 99477
u Newborn care continuum gains middle tier You can confidently use a new tool in your i...
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Gain $178 for Increased 99477 Work
4 Vignettes pin down initial newborn care differences Initial newborn care codes pay from...
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Reader Questions:
Change 3 Disease Codes on Your ICD-9 Bill
Question: We're trying to get up to speed on the ICD-9 2008 diagnoses that became effecti...
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Reader Questions:
Don't Switch Your Modifier 25 Base Code
Question: On claims involving 99381-99385, 99391-99395 and 99201-99215, may we append mo...
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Reader Questions:
Protect Moonlighting Coding With Q6
Question: Can we use modifiers Q5 and Q6 for non-credentialed "moonlighting" physicians? ...
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Reader Questions:
Clip 'N' Save Your Synagis Coverage Guide
Question: Insurers keep denying 90378 with 765.10. How can I obtain Synagis payment? Texa...
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You Be the Coder:
Check 2 Criteria for Hydration in 2008
Question: A pediatrician at our urgent care center ordered intravenous (IV) hydration for...
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