Pediatric Coding Alert
Critical Care:
99291-99292: Pediatric Critical Care Bundles Will Change Jan. 1
CPT also changes pediatric transport code bundles effective in 2011. Get ready for a whole... Read more
99291-99292: Pediatric Critical Care Bundles Will Change Jan. 1
CPT also changes pediatric transport code bundles effective in 2011. Get ready for a whole... Read more
Correct Coding Initiative:
Medicaid Started Instituting CCI Edits on Oct. 1 -- Use Modifiers Properly to Avoid Losing Money
Know where to find Correct Coding Initiative edits to ensure you're coding properly. If yo... Read more
Medicaid Started Instituting CCI Edits on Oct. 1 -- Use Modifiers Properly to Avoid Losing Money
Know where to find Correct Coding Initiative edits to ensure you're coding properly. If yo... Read more
CCI Edits:
Know How 'Medically Unlikely' CCI Edits Can Derail Your Reimbursement
Ignore the MUEs and expect a claim rejection. If you receive CCI-based denials from Medica... Read more
Know How 'Medically Unlikely' CCI Edits Can Derail Your Reimbursement
Ignore the MUEs and expect a claim rejection. If you receive CCI-based denials from Medica... Read more
Audits:
3 Steps Help You Get in the Swing of Self-Audits
The same audit process and timeline won't work for every office -- identify your prac... Read more
3 Steps Help You Get in the Swing of Self-Audits
The same audit process and timeline won't work for every office -- identify your prac... Read more
CORRECTION:
Use 41010, Not 40806 for Lingual Frenotomy
Pay attention to labial, lingual, "ec" when coding frenotomies. The Pediatric Coding Aler... Read more
Use 41010, Not 40806 for Lingual Frenotomy
Pay attention to labial, lingual, "ec" when coding frenotomies. The Pediatric Coding Aler... Read more
Reader Questions:
Submit All Claims to a Contracted Payer
Question: We have a patient who wants us to give her the allowable amounts for a procedur... Read more
Submit All Claims to a Contracted Payer
Question: We have a patient who wants us to give her the allowable amounts for a procedur... Read more
Reader Questions:
Report Fungal Sinusitis With Combination of Codes
Question: Is there is a specific diagnosis code for fungal sinusitis? Answer: Although lo... Read more
Report Fungal Sinusitis With Combination of Codes
Question: Is there is a specific diagnosis code for fungal sinusitis? Answer: Although lo... Read more
You Be the Coder:
Is "Calming Shot" Fee Allowed?
Question: One of our patients was on his way to have an MRI at the hospital. His mother s... Read more
Is "Calming Shot" Fee Allowed?
Question: One of our patients was on his way to have an MRI at the hospital. His mother s... Read more
Ear Coding Essentials:
3 Expert Tips Help You Code Ear Diagnoses With Ease
From otitis media to cerumen removal, we've got the answers to your ear coding quest... Read more
3 Expert Tips Help You Code Ear Diagnoses With Ease
From otitis media to cerumen removal, we've got the answers to your ear coding quest... Read more
Audit Areas:
2 Actions Protect Your E/M, Incident to, Observation Care Services from Paybacks
Private payer auditors will be targeting these pediatric practice error areas. If you ... Read more
2 Actions Protect Your E/M, Incident to, Observation Care Services from Paybacks
Private payer auditors will be targeting these pediatric practice error areas. If you ... Read more
Clip And Save:
Handle Your Ear Diagnoses With Care by Pinpointing Anatomic Site
Here's how to differentiate your pinna from your cochlea.Doctors who treat ear conditions ... Read more
Handle Your Ear Diagnoses With Care by Pinpointing Anatomic Site
Here's how to differentiate your pinna from your cochlea.Doctors who treat ear conditions ... Read more
Electronic Health Records:
Avoid These Pediatric EHR Coding Pitfalls -- And Find Out How to Collect Your Share of the $63,000 Per-Pediatrician Federal Incentive Bonus
If your EHR is prompting you to check one more exam area so you can upcode to a higher E/M... Read more
Avoid These Pediatric EHR Coding Pitfalls -- And Find Out How to Collect Your Share of the $63,000 Per-Pediatrician Federal Incentive Bonus
If your EHR is prompting you to check one more exam area so you can upcode to a higher E/M... Read more
Clarification:
799.51 Is Not for 'Pre' Diagnosis of ADD
These codes describe cognition problems due to neurologic trauma. The AHA Coding Clinic ... Read more
799.51 Is Not for 'Pre' Diagnosis of ADD
These codes describe cognition problems due to neurologic trauma. The AHA Coding Clinic ... Read more
Reader Questions:
Look to 'V' Code When Performing Hearing Screenings
Question: We performed a hearing screening on a 6-year-old patient and we aren't sure whic... Read more
Look to 'V' Code When Performing Hearing Screenings
Question: We performed a hearing screening on a 6-year-old patient and we aren't sure whic... Read more
Reader Questions:
Know the Regs for Treating Complex Feeding Disorders
Question: Our pediatrician is part of a team of professionals treating an eight-month-old ... Read more
Know the Regs for Treating Complex Feeding Disorders
Question: Our pediatrician is part of a team of professionals treating an eight-month-old ... Read more
Reader Questions:
Differentiate Pneumonia Diagnoses
Question: What is the difference between "lobar pneumonia" and "lobular pneumonia?" When t... Read more
Differentiate Pneumonia Diagnoses
Question: What is the difference between "lobar pneumonia" and "lobular pneumonia?" When t... Read more
You Be the Coder:
How Should We Report Pre-Op Clearance?
Question: An established patient who was about to undergo a bronchoscopy presented to our ... Read more
How Should We Report Pre-Op Clearance?
Question: An established patient who was about to undergo a bronchoscopy presented to our ... Read more
CPT 2011:
Goodbye 90465-90474, Hello Vaccine
You'll soon capture counseling per disease with universal multivaccine ICD-9 code.For comb... Read more
Goodbye 90465-90474, Hello Vaccine
You'll soon capture counseling per disease with universal multivaccine ICD-9 code.For comb... Read more
CPT 2011:
Vaccine Administration With Counseling
Codes 90460, +90461 allow RNs, LPNs, and more to use them. You'll be able to use m... Read more
Vaccine Administration With Counseling
Codes 90460, +90461 allow RNs, LPNs, and more to use them. You'll be able to use m... Read more
CPT 2011:
Easily Crosswalk Your Vaccine Product to Its 90460, 90461
How to count components for Boostrix, Pediarix --" and other immunizations. Excited by ... Read more
Easily Crosswalk Your Vaccine Product to Its 90460, 90461
How to count components for Boostrix, Pediarix --" and other immunizations. Excited by ... Read more
CPT 2011:
99224, 99225, 99226 Solve 'Middle Day' Code Dilemma
Observation services expansion eliminates payer coding variation.In 2011, coders will have... Read more
99224, 99225, 99226 Solve 'Middle Day' Code Dilemma
Observation services expansion eliminates payer coding variation.In 2011, coders will have... Read more
Reader Questions:
Local Treatment Could Unlock Burn Code Pay
Question: A patient reports to the ED with swelling and minor blisters on the tops of his ... Read more
Local Treatment Could Unlock Burn Code Pay
Question: A patient reports to the ED with swelling and minor blisters on the tops of his ... Read more
Reader Questions:
PostFBR EM: Is the Patient New or Established?
Question: Earlier this year, we saw a patient for splinter removal of the hand, which we c... Read more
PostFBR EM: Is the Patient New or Established?
Question: Earlier this year, we saw a patient for splinter removal of the hand, which we c... Read more
Reader Questions:
Look Into Options for Handling Late or No Show Patients
Question: We have a few patients who routinely miss appointments or show up late. We'd lik... Read more
Look Into Options for Handling Late or No Show Patients
Question: We have a few patients who routinely miss appointments or show up late. We'd lik... Read more
Reader Questions:
What Items Does 86580 Include?
Question: I would like to know the correct codes for billing a PPD test provided in the of... Read more
What Items Does 86580 Include?
Question: I would like to know the correct codes for billing a PPD test provided in the of... Read more
Reader Questions:
CPT 2011 Offers H1N1 Admin Code
Question: Medicare has its own H1N1 administration code. Does CPT?Answer: CPT 2011 will of... Read more
CPT 2011 Offers H1N1 Admin Code
Question: Medicare has its own H1N1 administration code. Does CPT?Answer: CPT 2011 will of... Read more
You Be the Coder:
Flu Pandemic, Hib-MenCY-TT Products Get Own Codes
Question: What CPT codes should I use for the influenza pandemic product?Answer: There are... Read more
Flu Pandemic, Hib-MenCY-TT Products Get Own Codes
Question: What CPT codes should I use for the influenza pandemic product?Answer: There are... Read more
ICD-9 2011:
488.1x Is Your New H1N1 Code
2 Details are critical in selecting the correct influenza diagnosis.Don't let rumors of fe... Read more
488.1x Is Your New H1N1 Code
2 Details are critical in selecting the correct influenza diagnosis.Don't let rumors of fe... Read more
Revenue Boosting Procedures:
29130, 29550, 28190: 3 Ways You Can Add an Additional $293 in Minor Procedure Pay
Finger splinting, buddy taping, splinter removal increase revenue without requiring comp... Read more
29130, 29550, 28190: 3 Ways You Can Add an Additional $293 in Minor Procedure Pay
Finger splinting, buddy taping, splinter removal increase revenue without requiring comp... Read more
Payer Spotlight:
96110 Modifier Requirements Change Again
BC/BS UHC, tell coder to halt 96110-59 denials with 96110-79.If you're ready to bill 96110... Read more
96110 Modifier Requirements Change Again
BC/BS UHC, tell coder to halt 96110-59 denials with 96110-79.If you're ready to bill 96110... Read more
E/M Essentials:
99211 Proper Use Relies on Dispelling These Myths
Hint: The 'nurse visit' code isn't just for nurses.Insurers know that 99211 is frequently ... Read more
99211 Proper Use Relies on Dispelling These Myths
Hint: The 'nurse visit' code isn't just for nurses.Insurers know that 99211 is frequently ... Read more
Practice Management:
Know Your State's Prompt Pay Laws -- And Appeal When Necessary
Medicare requires contractors to pay your clean claims within 30 days, but private payers ... Read more
Know Your State's Prompt Pay Laws -- And Appeal When Necessary
Medicare requires contractors to pay your clean claims within 30 days, but private payers ... Read more
Reader Questions:
99050 vs 99051: Which Code for Extended Flu Shot Hours?
Question: We are not usually open in the evenings or on the weekends, but we have decided ... Read more
99050 vs 99051: Which Code for Extended Flu Shot Hours?
Question: We are not usually open in the evenings or on the weekends, but we have decided ... Read more
Reader Questions:
Insurer Rules 99354 OK for Interpretive Services
Question: A level four office visit took 55 minutes of physician-patient face-to-face time... Read more
Insurer Rules 99354 OK for Interpretive Services
Question: A level four office visit took 55 minutes of physician-patient face-to-face time... Read more
Reader Questions:
Insurer Rules 99354 OK for Interpretive Services
Question: A level four office visit took 55 minutes of physician-patient face-to-face time... Read more
Insurer Rules 99354 OK for Interpretive Services
Question: A level four office visit took 55 minutes of physician-patient face-to-face time... Read more
Reader Questions:
2 Questions Decrease 99232 Compliance Risk
Question: When I audit my physicians' subsequent hospital care notes, I frequently find no... Read more
2 Questions Decrease 99232 Compliance Risk
Question: When I audit my physicians' subsequent hospital care notes, I frequently find no... Read more
Reader Questions:
J0559 Replaces J0530-J0550, Not Bicillin L-A Codes
Question: I thought I understood how to use J0530-J0550 but insurers are denying the codes... Read more
J0559 Replaces J0530-J0550, Not Bicillin L-A Codes
Question: I thought I understood how to use J0530-J0550 but insurers are denying the codes... Read more
You Be the Coder:
87804: Two Flu Tests, Three Coding Options
Question: A nurse tests a patient for both influenza A and B. She uses testing that involv... Read more
87804: Two Flu Tests, Three Coding Options
Question: A nurse tests a patient for both influenza A and B. She uses testing that involv... Read more
E/M Coding:
Watching the Clock Helps Determine When to Choose 99215
Tip: Split documentation to make calculations easier.If lengthy patient visits leave you w... Read more
Watching the Clock Helps Determine When to Choose 99215
Tip: Split documentation to make calculations easier.If lengthy patient visits leave you w... Read more
Billing 101:
5 Tips Speed Up New Patient Data Capture
A smart registration process can prevent claim-submission headaches.If you're trying to gr... Read more
5 Tips Speed Up New Patient Data Capture
A smart registration process can prevent claim-submission headaches.If you're trying to gr... Read more
Reader Questions:
Sometimes Mom-to-be Charge Is OK
Question: A new mom-to-be visited our office because her doctor expects a complicated deli... Read more
Sometimes Mom-to-be Charge Is OK
Question: A new mom-to-be visited our office because her doctor expects a complicated deli... Read more
Reader Questions:
Start With 99358 for Records Review
Question: I've heard that CPT has a new code for reviewing records separate from an appoin... Read more
Start With 99358 for Records Review
Question: I've heard that CPT has a new code for reviewing records separate from an appoin... Read more
Reader Questions:
40806 Represents Lingual Frenectomy
Question: The physician performed what he called a lingual frenotomy. The procedure she de... Read more
40806 Represents Lingual Frenectomy
Question: The physician performed what he called a lingual frenotomy. The procedure she de... Read more
Reader Questions:
40806 Represents Lingual Frenectomy
Question: The physician performed what he called a lingual frenotomy. The procedure she de... Read more
40806 Represents Lingual Frenectomy
Question: The physician performed what he called a lingual frenotomy. The procedure she de... Read more
Reader Questions:
Remember Modifiers for Multiple Screenings
Question: Insurers deny 96110 and/or 96110-59 when we bill both at an 18-month-old visit. ... Read more
Remember Modifiers for Multiple Screenings
Question: Insurers deny 96110 and/or 96110-59 when we bill both at an 18-month-old visit. ... Read more
Reader Questions:
Look Into Options for Handling Late or No Show Patients
Question: We have a few patients who routinely miss appointments or show up late.We'd like... Read more
Look Into Options for Handling Late or No Show Patients
Question: We have a few patients who routinely miss appointments or show up late.We'd like... Read more
Reader Questions:
Is 69210 Allowed for Partial Removal?
Question: Our pediatrician removed a small portion of impacted cerumen with a curette. How... Read more
Is 69210 Allowed for Partial Removal?
Question: Our pediatrician removed a small portion of impacted cerumen with a curette. How... Read more
Reader Questions:
Look for Local Txt to Up Sunburn Pay
Question: A mother brought her child to our office with swelling and minor blisters on the... Read more
Look for Local Txt to Up Sunburn Pay
Question: A mother brought her child to our office with swelling and minor blisters on the... Read more
You Be the Coder:
Biofreeze or Cryotherapy?
Question: A patient came to the office with a bump on her foot; the pediatrician diagnosed... Read more
Biofreeze or Cryotherapy?
Question: A patient came to the office with a bump on her foot; the pediatrician diagnosed... Read more
Category III Codes:
Shift 90650 HPV Vaccine From 'Pending' to 'Approved' List of Choices
Hint: Watch updated status for several flu vaccines. If July came and went without you... Read more
Shift 90650 HPV Vaccine From 'Pending' to 'Approved' List of Choices
Hint: Watch updated status for several flu vaccines. If July came and went without you... Read more
CCI 16.2:
Forget Reporting Telehealth Services With E/M Care
If your payer follows CCI, remember face-to-face outweighs other options.If any of your pa... Read more
Forget Reporting Telehealth Services With E/M Care
If your payer follows CCI, remember face-to-face outweighs other options.If any of your pa... Read more
ICD-9:
Follow These 4 Steps to Become an ICD-9 Coding Pro
Tip: Skip presenting complaints in outpatient setting if diagnosis is clear.Your CPT codes... Read more
Follow These 4 Steps to Become an ICD-9 Coding Pro
Tip: Skip presenting complaints in outpatient setting if diagnosis is clear.Your CPT codes... Read more
Reader Questions:
Count Extra Minutes Before Increasing E/M for Counseling
Question: We've found increased BMI during well visits for several children lately. The pe... Read more
Count Extra Minutes Before Increasing E/M for Counseling
Question: We've found increased BMI during well visits for several children lately. The pe... Read more
Reader Questions:
Single Code Covers Multiple Wart Removals
Question: When we code for removal of warts, do we use the code for each wart, or do the c... Read more
Single Code Covers Multiple Wart Removals
Question: When we code for removal of warts, do we use the code for each wart, or do the c... Read more
Reader Questions:
Multiple 96110's Are OK With Modifiers
Question: Our local Medicare carrier's rule has been that you could not bill 96110 multipl... Read more
Multiple 96110's Are OK With Modifiers
Question: Our local Medicare carrier's rule has been that you could not bill 96110 multipl... Read more
Reader Questions:
Examine Manifestations for Self Esteem Diagnosis
Question: A mother brought her child in because of self esteem concerns. Is there a diagno... Read more
Examine Manifestations for Self Esteem Diagnosis
Question: A mother brought her child in because of self esteem concerns. Is there a diagno... Read more
Reader Questions:
Watch Joint Movement for Correct Finger Splint
Question: What CPT and supply codes should we report for finger splinting? Pennsylvani... Read more
Watch Joint Movement for Correct Finger Splint
Question: What CPT and supply codes should we report for finger splinting? Pennsylvani... Read more
Reader Questions:
No Modifier 25 Needed for Vaccine With Well Check
Question: We often administer vaccines when we see patients for well baby visits. Do we ne... Read more
No Modifier 25 Needed for Vaccine With Well Check
Question: We often administer vaccines when we see patients for well baby visits. Do we ne... Read more
Reader Questions:
Follow Signature Rules or Risk Payments
Question: One of our physicians likes to sign everything with just his initials, or someti... Read more
Follow Signature Rules or Risk Payments
Question: One of our physicians likes to sign everything with just his initials, or someti... Read more
Reader Questions:
Clarify 'New' Versus 'Established' Patient
Question: Our practice performed a test on a patient another doctor referred to us. Our ph... Read more
Clarify 'New' Versus 'Established' Patient
Question: Our practice performed a test on a patient another doctor referred to us. Our ph... Read more
Reader Questions:
Clarify Temp Services Using Modifier Q6
Question: One of our physicians is taking some time off, and a temporary physician will ta... Read more
Clarify Temp Services Using Modifier Q6
Question: One of our physicians is taking some time off, and a temporary physician will ta... Read more
You Be the Coder:
Is Allergy Part of ROS or History?
Question: The provider documented NKDA (no known drug allergies) as part of a patient's ev... Read more
Is Allergy Part of ROS or History?
Question: The provider documented NKDA (no known drug allergies) as part of a patient's ev... Read more
Vaccines:
3 Myth Busters Prove Yes, You Can Get Paid for Unusual HPV Services
Find out what you should report when the patient decides against immunization.Coding for h... Read more
3 Myth Busters Prove Yes, You Can Get Paid for Unusual HPV Services
Find out what you should report when the patient decides against immunization.Coding for h... Read more
Summer Coding:
Let the Level of Complication Guide Your Tick Removal Choices
Watch for this key action before looking beyond E/M codes. A mother brings her daughte... Read more
Let the Level of Complication Guide Your Tick Removal Choices
Watch for this key action before looking beyond E/M codes. A mother brings her daughte... Read more
Test Yourself:
Draw the Line Between 'Brief' and 'Extended' HPI Levels
Hint: Simple signs like wet diapers might point to ROS, not HPI.Multi-symptoms patients ca... Read more
Draw the Line Between 'Brief' and 'Extended' HPI Levels
Hint: Simple signs like wet diapers might point to ROS, not HPI.Multi-symptoms patients ca... Read more
Reader Questions:
Look to V85.5x or 783.1 for Obesity Diagnosis
Question: The payer rejects my claims using codes from the 278.00- 278.02 family for patie... Read more
Look to V85.5x or 783.1 for Obesity Diagnosis
Question: The payer rejects my claims using codes from the 278.00- 278.02 family for patie... Read more
Reader Questions:
Match E/M and Diagnosis for PPD Test
Question: The insurance company bundles an office visit with the code for PPD administrati... Read more
Match E/M and Diagnosis for PPD Test
Question: The insurance company bundles an office visit with the code for PPD administrati... Read more
Reader Questions:
Circumstances Dictate V Code for Lead Test
Question: An insurance company denied our claim for a lead test because we submitted a V c... Read more
Circumstances Dictate V Code for Lead Test
Question: An insurance company denied our claim for a lead test because we submitted a V c... Read more
Reader Questions:
Claim Timing Could Keep Away 90670 Pay
Question:We've had trouble being paid for 90670. What diagnosis should we report, and shou... Read more
Claim Timing Could Keep Away 90670 Pay
Question:We've had trouble being paid for 90670. What diagnosis should we report, and shou... Read more
Reader Questions:
Best Code for Pediatric Symptoms Checklist Tool
Question: My physicians would like a code for "pediatric symptoms checklist", which is a s... Read more
Best Code for Pediatric Symptoms Checklist Tool
Question: My physicians would like a code for "pediatric symptoms checklist", which is a s... Read more
Reader Questions:
No Reporting for Incomplete Well-Check Visit
Question: A mother brought her daughter for a well child check-up, although she didn'... Read more
No Reporting for Incomplete Well-Check Visit
Question: A mother brought her daughter for a well child check-up, although she didn'... Read more
Reader Questions:
Remember V Code for Suture Removal
Question: An established patient hit his forehead on his surfboard while on vacation in Ha... Read more
Remember V Code for Suture Removal
Question: An established patient hit his forehead on his surfboard while on vacation in Ha... Read more
Reader Questions:
Continuous Vs. Return Determines Newborn Status Change
Question: I'm coding for a newborn who was normal for the first two days and developed tac... Read more
Continuous Vs. Return Determines Newborn Status Change
Question: I'm coding for a newborn who was normal for the first two days and developed tac... Read more
Reader Questions:
Watch Filing Details for Secondary Medicaid
Question: How do we correctly submit claims when Medicaid is the secondary insurance?Virgi... Read more
Watch Filing Details for Secondary Medicaid
Question: How do we correctly submit claims when Medicaid is the secondary insurance?Virgi... Read more
You Be the Coder:
Rotavirus Vaccines Explained
Question: Can you explain when we use the different rotavirus vaccine codes?Maine Subscrib... Read more
Rotavirus Vaccines Explained
Question: Can you explain when we use the different rotavirus vaccine codes?Maine Subscrib... Read more
Vaccines:
Timing and Patient Age Make All the Difference When Giving Catch-Up Immunizations
Check out the new V code that helps you explain catch-up immunizations to your payers.If y... Read more
Timing and Patient Age Make All the Difference When Giving Catch-Up Immunizations
Check out the new V code that helps you explain catch-up immunizations to your payers.If y... Read more
Summer Care:
Don't Get Burned by Overlooking 16000 for Sunburn Treatment
Add almost $65 to the bank when you meet this simple criterion.Sunburns can possibly quali... Read more
Don't Get Burned by Overlooking 16000 for Sunburn Treatment
Add almost $65 to the bank when you meet this simple criterion.Sunburns can possibly quali... Read more
Clip & Save:
Fracture Care Includes a Lot, But Remember to Code Supplies Every Time
Keep this handy list to distinguish between A, L, and Q code options.Although cast applica... Read more
Fracture Care Includes a Lot, But Remember to Code Supplies Every Time
Keep this handy list to distinguish between A, L, and Q code options.Although cast applica... Read more
Reader Questions:
Back Up 99058 With Adequate Documentation
Question: Our pediatrician wants to start billing 99058 when an emergency interrupts other... Read more
Back Up 99058 With Adequate Documentation
Question: Our pediatrician wants to start billing 99058 when an emergency interrupts other... Read more
Reader Questions:
Look to 88720 for Bilirubin Assessment Tool
Question: Our physician just purchased a non-invasive bilirubin assessment tool. What CPT ... Read more
Look to 88720 for Bilirubin Assessment Tool
Question: Our physician just purchased a non-invasive bilirubin assessment tool. What CPT ... Read more
Reader Questions:
No Modifier Needed for ER Suture Follow-Up
Question: An 11-year-old established patient went to the Emergency Room over the weekend b... Read more
No Modifier Needed for ER Suture Follow-Up
Question: An 11-year-old established patient went to the Emergency Room over the weekend b... Read more
Reader Questions:
V72.11 Should Cover Follow-Up Hearing Screen
Question: A new patient came to our office for a hearing screening because she failed it a... Read more
V72.11 Should Cover Follow-Up Hearing Screen
Question: A new patient came to our office for a hearing screening because she failed it a... Read more
Reader Questions:
Consider Reason Before Coding 99401
Question: Is reporting 99401 for perinatal counseling of a mom-to-be allowed? If so, what ... Read more
Consider Reason Before Coding 99401
Question: Is reporting 99401 for perinatal counseling of a mom-to-be allowed? If so, what ... Read more
Reader Questions:
300.29 Is Best Diagnosis for Emetophobia
Question: What diagnosis code applies to "emetophobia," the fear of vomiting?Virginia Subs... Read more
300.29 Is Best Diagnosis for Emetophobia
Question: What diagnosis code applies to "emetophobia," the fear of vomiting?Virginia Subs... Read more
Reader Questions:
Use History of Disease Only If It's "History"
Question: At what point should I report a "history of" code instead of the actual cancer d... Read more
Use History of Disease Only If It's "History"
Question: At what point should I report a "history of" code instead of the actual cancer d... Read more
Reader Questions:
Check If Exceptions Exist in Fracture Modifiers
Question: A parent brings her 14-year-old son to the office with an injured right finger h... Read more
Check If Exceptions Exist in Fracture Modifiers
Question: A parent brings her 14-year-old son to the office with an injured right finger h... Read more
Reader Questions:
Check Out PECOS, Keep Your Pay Coming
Question: A friend at another pediatrician's office said they're signing up for PECOS to b... Read more
Check Out PECOS, Keep Your Pay Coming
Question: A friend at another pediatrician's office said they're signing up for PECOS to b... Read more
You Be the Coder:
Avoid the trap of 99360 with 99464
Question: Our provider spent about 30 minutes on stand-by for a scheduled cesarean deliver... Read more
Avoid the trap of 99360 with 99464
Question: Our provider spent about 30 minutes on stand-by for a scheduled cesarean deliver... Read more
Report 99050 for 'Above and Beyond' Care and Reap the Benefits
Highlight the phrase "in addition to basic service"--you'll be glad you did. Pediatrician... Read more
Highlight the phrase "in addition to basic service"--you'll be glad you did. Pediatrician... Read more
Breathe Easy Knowing You're Updated on Common Spirometry Tests
Hint: You might not need as many codes on the claim as you expect. CPT 2010 lists several... Read more
Hint: You might not need as many codes on the claim as you expect. CPT 2010 lists several... Read more
News You Can Use:
Treating Pneumococcal Infections? Prevnar 13 Replaces Prevnar 7
Find out what corresponding V code you should report with 90670. Get ready to change your... Read more
Treating Pneumococcal Infections? Prevnar 13 Replaces Prevnar 7
Find out what corresponding V code you should report with 90670. Get ready to change your... Read more
Clarification
As discussed in Pediatric Coding Alert (Vol. 13, No. 3), you can bill multiple instances o... Read more
As discussed in Pediatric Coding Alert (Vol. 13, No. 3), you can bill multiple instances o... Read more
Reader Questions:
Your Depression Diagnosis Depends on Physician
Question: We see a patient each week to monitor her medication for depression. What is th... Read more
Your Depression Diagnosis Depends on Physician
Question: We see a patient each week to monitor her medication for depression. What is th... Read more
Reader Questions:
Turn to 271.8 for 3-MCC Diagnosis
Question: What is the best diagnosis for 3-MCC (3-Methylcrotonyl-Coenzyme A carboxylase d... Read more
Turn to 271.8 for 3-MCC Diagnosis
Question: What is the best diagnosis for 3-MCC (3-Methylcrotonyl-Coenzyme A carboxylase d... Read more
Reader Questions:
Go With 94760 for Pulse Oximetry
Question: We are beginning to offer oxygen saturations and pulse readings in the office. ... Read more
Go With 94760 for Pulse Oximetry
Question: We are beginning to offer oxygen saturations and pulse readings in the office. ... Read more
Reader Questions:
82962 Can Be OK for Home Use
Question: A payer denied our claim for 82962. Is there any way to get paid for it? Connec... Read more
82962 Can Be OK for Home Use
Question: A payer denied our claim for 82962. Is there any way to get paid for it? Connec... Read more
Reader Questions:
Yes, You Can Bill TB Test Check
Question: We were told that we could bill Medicaid when our physician reads TB test resul... Read more
Yes, You Can Bill TB Test Check
Question: We were told that we could bill Medicaid when our physician reads TB test resul... Read more
Reader Questions:
Include Supporting Symptoms for Metabolic Test
Question: A locum tenens who filled in while our pediatrician was out of the office noted... Read more
Include Supporting Symptoms for Metabolic Test
Question: A locum tenens who filled in while our pediatrician was out of the office noted... Read more
Reader Questions:
Parental Concern Offers Behavior Visit Clues
Question: Parents sometimes come to the office to talk with our physicians about the chil... Read more
Parental Concern Offers Behavior Visit Clues
Question: Parents sometimes come to the office to talk with our physicians about the chil... Read more
Reader Questions:
781.99 Is Best Sensory Integration Disorder Choice
Question: What diagnosis should we submit for sensory integration disorder? Nevada Subscr... Read more
781.99 Is Best Sensory Integration Disorder Choice
Question: What diagnosis should we submit for sensory integration disorder? Nevada Subscr... Read more
Reader Questions:
Remember Modifiers for 99391 With 17250
Question: What is the correct way to bill 99391 and 17250 during the same encounter in th... Read more
Remember Modifiers for 99391 With 17250
Question: What is the correct way to bill 99391 and 17250 during the same encounter in th... Read more
Reader Questions:
Look to 96110 for M-CHAT Screening
Question: What is the best code for administering the M-CHAT screening? Do we need to inc... Read more
Look to 96110 for M-CHAT Screening
Question: What is the best code for administering the M-CHAT screening? Do we need to inc... Read more
Reader Questions:
Choose Consult Code for Surgery Prep Visit
Question: Humana denied our claim with 99212 and diagnosis V70.3. Should we code medical ... Read more
Choose Consult Code for Surgery Prep Visit
Question: Humana denied our claim with 99212 and diagnosis V70.3. Should we code medical ... Read more
You Be the Coder:
Reporting 69200 As A Bilateral Procedure
Question: Is 69200 a bilateral procedure, or do we need to include a modifier if the pedi... Read more
Reporting 69200 As A Bilateral Procedure
Question: Is 69200 a bilateral procedure, or do we need to include a modifier if the pedi... Read more
Face Off Against Common Sports Physical Coding Challenges
Hint: Gathering upfront pay and watching E/Ms make a difference.Children need physicals to... Read more
Hint: Gathering upfront pay and watching E/Ms make a difference.Children need physicals to... Read more
Clear the Way for Accurate Diagnostic Test Documentation
Technical and professional components hold your clues.What do insurers expect for document... Read more
Technical and professional components hold your clues.What do insurers expect for document... Read more
News You Can Use:
Change These J Codes In Your System
As noted in Pediatric Coding Alert, Vol. 13, Number 2, January 2010 brought a replacement ... Read more
Change These J Codes In Your System
As noted in Pediatric Coding Alert, Vol. 13, Number 2, January 2010 brought a replacement ... Read more
3 Tips Ensure You Don't Cause a Stir With Your Incident-to Billing
If you automatically report under your NPP, you're costing your doc 15%.Being able to repo... Read more
If you automatically report under your NPP, you're costing your doc 15%.Being able to repo... Read more
Correction:
789.04 is for lower left quadrant abdominal pain
Pediatric Coding Alert, Volume 13, Number 1,incorrectly listed the ICD-9 diagnosis codes ... Read more
789.04 is for lower left quadrant abdominal pain
Pediatric Coding Alert, Volume 13, Number 1,incorrectly listed the ICD-9 diagnosis codes ... Read more
READER QUESTIONS:
Code Each Unit for Multiple +90472s
Question: We often administer multiple vaccines during a patient's visit, but I am not sur... Read more
Code Each Unit for Multiple +90472s
Question: We often administer multiple vaccines during a patient's visit, but I am not sur... Read more
READER QUESTIONS:
Try More Diagnoses With 51701
Question: A father brought in his child who's had a fever of 102 degrees for several days.... Read more
Try More Diagnoses With 51701
Question: A father brought in his child who's had a fever of 102 degrees for several days.... Read more
READER QUESTIONS:
Verify Documentation for E/M With 69210
Question: A patient presented with ear pain. The doctor used a curette to remove impacted ... Read more
Verify Documentation for E/M With 69210
Question: A patient presented with ear pain. The doctor used a curette to remove impacted ... Read more
READER QUESTIONS:
Consider Different Diagnosis for Synagis Injections
Question: Our nurse practitioner often administers Synagis injections to premature babies.... Read more
Consider Different Diagnosis for Synagis Injections
Question: Our nurse practitioner often administers Synagis injections to premature babies.... Read more
READER QUESTIONS:
Coding E/M Service With Foreign Body Removal Is Legitimate
Question: A 3-year-old child with a history of bad breath was brought to the office. After... Read more
Coding E/M Service With Foreign Body Removal Is Legitimate
Question: A 3-year-old child with a history of bad breath was brought to the office. After... Read more
You Be the Coder :
Coding Double Nosebleed Care
Question: An established patient reports to the pediatrician after a ball hit her in the... Read more
Coding Double Nosebleed Care
Question: An established patient reports to the pediatrician after a ball hit her in the... Read more
Stitch Up Successful Suture Removal Coding
Watch original service and wound assessment to know when -- and what -- to repo... Read more
Watch original service and wound assessment to know when -- and what -- to repo... Read more
How Much ROS Documentation Is Enough?
Keep sufficient paperwork on hand to back up EHR. Transitioning to the world of electroni... Read more
Keep sufficient paperwork on hand to back up EHR. Transitioning to the world of electroni... Read more
Definition:
Brush Up on What Constitutes ROS
Document systems like CMS counts them. CMS has specific guidelines regarding how physicia... Read more
Brush Up on What Constitutes ROS
Document systems like CMS counts them. CMS has specific guidelines regarding how physicia... Read more
Remember 3 Points for 'Normal' to 'Critical' Progression of Care
Yes, you can sometimes look past newborn critical care codes. Coding for newborn care... Read more
Yes, you can sometimes look past newborn critical care codes. Coding for newborn care... Read more
READER QUESTIONS:
Check CCI Edits for Office Visit
Question: A payer denied our claim for an established patient office visit in addition to... Read more
Check CCI Edits for Office Visit
Question: A payer denied our claim for an established patient office visit in addition to... Read more
READER QUESTIONS:
Choose Between 917.8, 917.9 for Toe Tourniquet
Question: The physician removed a "hair tourniquet" of human hair wound tightly around a ... Read more
Choose Between 917.8, 917.9 for Toe Tourniquet
Question: The physician removed a "hair tourniquet" of human hair wound tightly around a ... Read more
READER QUESTIONS:
No True Code for Family Medical Chart Review
Question: One of our patient's families will potentially be adopting a child and have ask... Read more
No True Code for Family Medical Chart Review
Question: One of our patient's families will potentially be adopting a child and have ask... Read more
READER QUESTIONS:
Apply V79.8 for Postnatal Depression Screening Dx
Question: What diagnosis should we report with 99420 for postnatal depression screenings?... Read more
Apply V79.8 for Postnatal Depression Screening Dx
Question: What diagnosis should we report with 99420 for postnatal depression screenings?... Read more
READER QUESTIONS:
Multiple Friction Burns from Treadmill
Question: A three-year-old child was brought in with multiple friction burns from a tread... Read more
Multiple Friction Burns from Treadmill
Question: A three-year-old child was brought in with multiple friction burns from a tread... Read more
READER QUESTIONS:
90471, 90663 Work for H1N1 Split Vaccine
Question: A child came to our office for the H1N1 vaccine; she received the initial vacci... Read more
90471, 90663 Work for H1N1 Split Vaccine
Question: A child came to our office for the H1N1 vaccine; she received the initial vacci... Read more
READER QUESTIONS:
Avoid Multi-Vaccine Denial
Question: Our physician billed 90634, 90710, and 90606 for vaccines given to a 5-year-old... Read more
Avoid Multi-Vaccine Denial
Question: Our physician billed 90634, 90710, and 90606 for vaccines given to a 5-year-old... Read more
You Be the Coder :
Get the Lowdown on Reporting J0540
Question: We've reported J0540 for years, but Medicaid denied one of our recent claims. H... Read more
Get the Lowdown on Reporting J0540
Question: We've reported J0540 for years, but Medicaid denied one of our recent claims. H... Read more
Location Is Everything When You Report Abdominal Pain
Follow these 3 tips for successful coding now -- and later. The term "abdominal pain... Read more
Follow these 3 tips for successful coding now -- and later. The term "abdominal pain... Read more
Prepare to Shift Codes as Newborn Status Changes
Here's your step-by-step guide to each type of care. Choosing the appropriate codes for i... Read more
Here's your step-by-step guide to each type of care. Choosing the appropriate codes for i... Read more
Identify All HPI Elements for the Most Accurate E/M Coding
Review your coding basics to potentially move to a higher level. Thinking of starting rou... Read more
Review your coding basics to potentially move to a higher level. Thinking of starting rou... Read more
Check That Your Newborn Codes Are Correct
Let this chart help ensure you've made the right old/new move. Although CPT 2009 introduc... Read more
Let this chart help ensure you've made the right old/new move. Although CPT 2009 introduc... Read more
Reader questions:
Verify Coverage Before 30-Month Check
Question: Is it acceptable to offer (and charge for) 30-month visits? If so, how do we ha... Read more
Verify Coverage Before 30-Month Check
Question: Is it acceptable to offer (and charge for) 30-month visits? If so, how do we ha... Read more
Reader questions:
Ask Whether Payer Wants 59 With +90472
Question: A pediatrician gives multiple vaccines during a visit. Do we include modifier 5... Read more
Ask Whether Payer Wants 59 With +90472
Question: A pediatrician gives multiple vaccines during a visit. Do we include modifier 5... Read more
Reader questions:
Nix 99464 If Your MD Misses the Delivery
Question: Prior to delivery, an obstetrician asked that one of our pediatricians be prese... Read more
Nix 99464 If Your MD Misses the Delivery
Question: Prior to delivery, an obstetrician asked that one of our pediatricians be prese... Read more
Reader questions:
Select L3908 for Colle Wrist Splint if Possible
Question: Can we code for a colle wrist splint? If so, how do I choose between CPT and HC... Read more
Select L3908 for Colle Wrist Splint if Possible
Question: Can we code for a colle wrist splint? If so, how do I choose between CPT and HC... Read more
You Be the Coder:
Backup Option for V20.32
Question: Our Medicaid carrier denies 99391 when we bill it with diagnosis code V20.32. I... Read more
Backup Option for V20.32
Question: Our Medicaid carrier denies 99391 when we bill it with diagnosis code V20.32. I... Read more