Pediatric Coding Alert
News You Can Use:
Stay Up to Date With This 2020 PFS Overview
E/M revisions continue apace, while PCM gets a much-needed introduction. Do you know what... Read more
Stay Up to Date With This 2020 PFS Overview
E/M revisions continue apace, while PCM gets a much-needed introduction. Do you know what... Read more
Year in Review Quiz:
Is Your Coding Cognition Current? Take Our 2019 Year-in-Review Quiz
The answers to these 4 questions will help you look back, forward to 2020 and beyond. Do ... Read more
Is Your Coding Cognition Current? Take Our 2019 Year-in-Review Quiz
The answers to these 4 questions will help you look back, forward to 2020 and beyond. Do ... Read more
Mythbusters:
Unpack These 3 Myths to Unbundle Procedures Correctly
Understand the wrong, and the right, ways to use modifier 59. Like many coders, you've pr... Read more
Unpack These 3 Myths to Unbundle Procedures Correctly
Understand the wrong, and the right, ways to use modifier 59. Like many coders, you've pr... Read more
Coding Quiz Answers:
Check Your Answers to Our 2019 Year-in-Review Coding Quiz
Find out if your coding knowledge is up to date. Once you've answered the quiz questions ... Read more
Check Your Answers to Our 2019 Year-in-Review Coding Quiz
Find out if your coding knowledge is up to date. Once you've answered the quiz questions ... Read more
Reader Question:
Don't Let This E/M Encounter Fall Short on Time
Question: One of our pediatricians billed 99203 using time to meet the level. The document... Read more
Don't Let This E/M Encounter Fall Short on Time
Question: One of our pediatricians billed 99203 using time to meet the level. The document... Read more
Reader Question:
Encounter These Dx Codes for Immunization Review
Question: If a patient comes in to have our pediatrician review, and then sign off on, an ... Read more
Encounter These Dx Codes for Immunization Review
Question: If a patient comes in to have our pediatrician review, and then sign off on, an ... Read more
Reader Question:
Use E/M, not Lab Code, for Sample Collection
Question: If our office collects samples to send to the lab to test for human papillomavir... Read more
Use E/M, not Lab Code, for Sample Collection
Question: If our office collects samples to send to the lab to test for human papillomavir... Read more
You Be the Coder:
Know How, How Not to Report Sick, Well Visits Together
Question: I code for a pediatrician that wants to add an additional evaluation and managem... Read more
Know How, How Not to Report Sick, Well Visits Together
Question: I code for a pediatrician that wants to add an additional evaluation and managem... Read more
Mythbusters:
Bust These 3 Myths for On-Point Immunization Coding
Hint: Pay attention to NCCI edit pairs. Immunization season is here, so it's time for a r... Read more
Bust These 3 Myths for On-Point Immunization Coding
Hint: Pay attention to NCCI edit pairs. Immunization season is here, so it's time for a r... Read more
Guidelines:
Get Answers to All Your After Hours/Special Service Questions With This FAQ
Let these 3 answers and 4 notes of caution add up to accurate coding. Your pediatrician s... Read more
Get Answers to All Your After Hours/Special Service Questions With This FAQ
Let these 3 answers and 4 notes of caution add up to accurate coding. Your pediatrician s... Read more
Case Study Corner:
Can You Code This Fetal Alcohol Syndrome Case Study?
Don't forget to factor in prolonged care time. A 6-month-old patient presents to your pro... Read more
Can You Code This Fetal Alcohol Syndrome Case Study?
Don't forget to factor in prolonged care time. A 6-month-old patient presents to your pro... Read more
Reader Question:
Take In This Code Choice for Vaping Use
Question: One of our adolescent patients just came in seeking to give up vaping following ... Read more
Take In This Code Choice for Vaping Use
Question: One of our adolescent patients just came in seeking to give up vaping following ... Read more
Reader Question:
Don't Let This Encounter Code Choice Come Back to Bite
Question: A young patient came to us after being bitten by a squirrel. Though the patient ... Read more
Don't Let This Encounter Code Choice Come Back to Bite
Question: A young patient came to us after being bitten by a squirrel. Though the patient ... Read more
Reader Question:
Decide This NEC/NOS Dilemma
Question: Can you explain to this coding newbie the difference between Not Elsewhere Class... Read more
Decide This NEC/NOS Dilemma
Question: Can you explain to this coding newbie the difference between Not Elsewhere Class... Read more
You Be the Coder:
Test Your Screening Knowledge With This ASQ Dilemma
Question: In our practice, we routinely use the Ages and Stages (ASQ) developmental screen... Read more
Test Your Screening Knowledge With This ASQ Dilemma
Question: In our practice, we routinely use the Ages and Stages (ASQ) developmental screen... Read more
News You Can Use:
Get on Board With These CPT® Online Service Code Revisions
Significant deletions, revisions are coming to virtual E/M. The digital world is constant... Read more
Get on Board With These CPT® Online Service Code Revisions
Significant deletions, revisions are coming to virtual E/M. The digital world is constant... Read more
CPT® 2020 Revisions:
Take Note of These RPM, ABPM, SMBP, Vaccine Code Changes
Get ready for January 1, 2020, with this quick guide to the latest CPT® revisions. CPT®... Read more
Take Note of These RPM, ABPM, SMBP, Vaccine Code Changes
Get ready for January 1, 2020, with this quick guide to the latest CPT® revisions. CPT®... Read more
Condition Spotlight:
Follow These Guidelines for Accurate UTI Reporting
Hint: Be wary of unspecified codes and definitive Dx without infectious agent. According ... Read more
Follow These Guidelines for Accurate UTI Reporting
Hint: Be wary of unspecified codes and definitive Dx without infectious agent. According ... Read more
Reader Question:
Use These Codes to Resolve This OM Scenario
Question: One of our young patients just came back for a recheck after being diagnosed wit... Read more
Use These Codes to Resolve This OM Scenario
Question: One of our young patients just came back for a recheck after being diagnosed wit... Read more
Reader Question:
Patient Status Helps Determine Dx Decision
Question: One of our pediatricians just diagnosed a new patient with acute sinusitis and c... Read more
Patient Status Helps Determine Dx Decision
Question: One of our pediatricians just diagnosed a new patient with acute sinusitis and c... Read more
Reader Question:
Decide to Defy Patient Dx
Question: Our provider used the words “personal history of oppositional defiant disorder... Read more
Decide to Defy Patient Dx
Question: Our provider used the words “personal history of oppositional defiant disorder... Read more
You Be the Coder:
Evaluate This Counseling Scenario, Manage Your Documentation Correctly
Question: If I am billing an evaluation and management (E/M) encounter by time, does docum... Read more
Evaluate This Counseling Scenario, Manage Your Documentation Correctly
Question: If I am billing an evaluation and management (E/M) encounter by time, does docum... Read more
E/M Coding:
Check Your Virtual Check-In Coding Comprehension
Use this FAQ, know when you can, cannot bill for telephone E/Ms. If your pediatrician is ... Read more
Check Your Virtual Check-In Coding Comprehension
Use this FAQ, know when you can, cannot bill for telephone E/Ms. If your pediatrician is ... Read more
Guidelines:
Do These 4 Things to Keep Your PFSH Documentation Clean
Know your history by learning these pro tips. You may know all the elements that go into ... Read more
Do These 4 Things to Keep Your PFSH Documentation Clean
Know your history by learning these pro tips. You may know all the elements that go into ... Read more
Procedure Coding:
Follow This Guide for Scrupulous Suture Removal Coding
And make sure these modifiers don't make a mess of your claim. It's a fact: kids get hurt... Read more
Follow This Guide for Scrupulous Suture Removal Coding
And make sure these modifiers don't make a mess of your claim. It's a fact: kids get hurt... Read more
Reader Question:
Know Congenital, Acquired for Laterality in Short Limb Dx
Question: Our pediatrician saw a patient and documented that the patient's left femur and ... Read more
Know Congenital, Acquired for Laterality in Short Limb Dx
Question: Our pediatrician saw a patient and documented that the patient's left femur and ... Read more
Reader Question:
Seek This Modifier Substitution Solution
Question: We have been billing 94640 with 94664, using modifier 59 on the nebulizer d... Read more
Seek This Modifier Substitution Solution
Question: We have been billing 94640 with 94664, using modifier 59 on the nebulizer d... Read more
Reader Question:
Look Past Index to Find Fungal Sinusitis Dx
Question: Our pediatrician diagnosed one of our patients with fungal sinusitis, but I can'... Read more
Look Past Index to Find Fungal Sinusitis Dx
Question: Our pediatrician diagnosed one of our patients with fungal sinusitis, but I can'... Read more
You Be the Coder:
Bring These Codes Onboard for Online Addiction
Question: A mother came in with her daughter concerned that she was spending too much time... Read more
Bring These Codes Onboard for Online Addiction
Question: A mother came in with her daughter concerned that she was spending too much time... Read more
News You Can Use:
Stay on Top of These New ICD-10 Codes, Guidelines
Know what's going to affect your coding come October 1. While this year's changes to the ... Read more
Stay on Top of These New ICD-10 Codes, Guidelines
Know what's going to affect your coding come October 1. While this year's changes to the ... Read more
Coding Quiz:
Answer These Questions, Master Modifier 25 Use
And sort out these scenarios to add to your understanding. You've used modifier 25 (Signi... Read more
Answer These Questions, Master Modifier 25 Use
And sort out these scenarios to add to your understanding. You've used modifier 25 (Signi... Read more
Procedure Coding:
Follow These Steps to Strapping and Splinting Success
And solve this encounter to sharpen your skills. As simple as strapping and splinting pro... Read more
Follow These Steps to Strapping and Splinting Success
And solve this encounter to sharpen your skills. As simple as strapping and splinting pro... Read more
Coding Quiz Answers:
Check Your Answers to Our Modifier 25 Coding Quiz
Find out if you have what it takes to be a modifier master. Once you've answered the quiz... Read more
Check Your Answers to Our Modifier 25 Coding Quiz
Find out if you have what it takes to be a modifier master. Once you've answered the quiz... Read more
Reader Question:
Document BMI, Increase Knowledge
Question: If a patient's body mass index (BMI) is in the normal range, do we need to inclu... Read more
Document BMI, Increase Knowledge
Question: If a patient's body mass index (BMI) is in the normal range, do we need to inclu... Read more
Reader Question:
Locate These Codes for Diaper Rash Relief
Question: Our pediatrician recently saw an infant that presented with a severe case o... Read more
Locate These Codes for Diaper Rash Relief
Question: Our pediatrician recently saw an infant that presented with a severe case o... Read more
You Be the Coder:
Don't Take a Risk on Prescription Refill Reporting
Question: Can you count a routine prescription refill as a moderate level of risk whe... Read more
Don't Take a Risk on Prescription Refill Reporting
Question: Can you count a routine prescription refill as a moderate level of risk whe... Read more
Condition Spotlight:
Add This Advice to Your Asthma Coding Armory
Use this guide to capture conditions correctly. You know that the J45.- (Asthma) codes ar... Read more
Add This Advice to Your Asthma Coding Armory
Use this guide to capture conditions correctly. You know that the J45.- (Asthma) codes ar... Read more
Guidelines:
Can You Solve These 4 Neonatal Transfer of Care Scenarios?
Get them wrong, and your bottom line could be in jeopardy. The days after a child is born... Read more
Can You Solve These 4 Neonatal Transfer of Care Scenarios?
Get them wrong, and your bottom line could be in jeopardy. The days after a child is born... Read more
Clip & Save:
Use This Chart to Code Common Summer Conditions
And make sure you have your E/M, procedure coding ready to roll. Summer is the time for c... Read more
Use This Chart to Code Common Summer Conditions
And make sure you have your E/M, procedure coding ready to roll. Summer is the time for c... Read more
Reader Question:
Assess Modifier Use in This Multiple Test Claim
Question: I have a question regarding administering the Vanderbilt assessment. We typicall... Read more
Assess Modifier Use in This Multiple Test Claim
Question: I have a question regarding administering the Vanderbilt assessment. We typicall... Read more
Reader Question:
Stick to Specificity in This Dx Dilemma
Question: One of our pediatricians documented a patient's chief complaint as abdominal pai... Read more
Stick to Specificity in This Dx Dilemma
Question: One of our pediatricians documented a patient's chief complaint as abdominal pai... Read more
You Be the Coder:
Beware of Procedure Type, Global Period, in This Neonate Encounter
Question: Our pediatrician just performed services for a newborn. On the first day, she pe... Read more
Beware of Procedure Type, Global Period, in This Neonate Encounter
Question: Our pediatrician just performed services for a newborn. On the first day, she pe... Read more
Practice Management:
Take These 4 Simple Steps, Perform Successful, Stress-Free Self-Audits, Part 2
Local analysis and education provide valuable lessons … literally. In last month's Pedi... Read more
Take These 4 Simple Steps, Perform Successful, Stress-Free Self-Audits, Part 2
Local analysis and education provide valuable lessons … literally. In last month's Pedi... Read more
E/M Coding:
Get All Your 99211 Questions Answered With This FAQ
Find out who should provide the service, and how and when it should be documented. Of all... Read more
Get All Your 99211 Questions Answered With This FAQ
Find out who should provide the service, and how and when it should be documented. Of all... Read more
Case Study Corner:
Know Acne Type, Procedures, to Ace This Case Study
And peek into payer policies to avoid cosmetic procedure problems. For many adolescents, ... Read more
Know Acne Type, Procedures, to Ace This Case Study
And peek into payer policies to avoid cosmetic procedure problems. For many adolescents, ... Read more
Reader Question:
Document Key Factors to Avoid Immunization Denials
Question: Our pediatric practice is receiving denials on 90460/90461. What should we do to... Read more
Document Key Factors to Avoid Immunization Denials
Question: Our pediatric practice is receiving denials on 90460/90461. What should we do to... Read more
Reader Question:
Factor Service Type Into This New vs. Established Calculation
Question: A patient came in for an evaluation and management (E/M) service on February 19,... Read more
Factor Service Type Into This New vs. Established Calculation
Question: A patient came in for an evaluation and management (E/M) service on February 19,... Read more
You Be the Coder:
Enhance the E/M in this Epistaxis Encounter
Question: Our pediatrician just saw an established patient with a nosebleed. The patient's... Read more
Enhance the E/M in this Epistaxis Encounter
Question: Our pediatrician just saw an established patient with a nosebleed. The patient's... Read more
Practice Management:
Take These 4 Steps to Perform Successful, Stress-Free Self-Audits: Part 1
Our experts offer insights, proven strategies for this important management tool. Self-au... Read more
Take These 4 Steps to Perform Successful, Stress-Free Self-Audits: Part 1
Our experts offer insights, proven strategies for this important management tool. Self-au... Read more
Guidelines:
Make the Decision, Add Up the Points in This MDM Calculation
And know that numbers alone don't always equate to the correct E/M level. More than histo... Read more
Make the Decision, Add Up the Points in This MDM Calculation
And know that numbers alone don't always equate to the correct E/M level. More than histo... Read more
Clip & Save:
Use This Chart for Accurate ADHD/ADD/Coexistent Condition Coding
Don't let subtle differences between conditions lead to coding errors. On the surface, di... Read more
Use This Chart for Accurate ADHD/ADD/Coexistent Condition Coding
Don't let subtle differences between conditions lead to coding errors. On the surface, di... Read more
Reader Question:
Keep Areas, Systems Separate for Accurate E/M Levels
Question: We are performing a voluntary self-audit of our evaluation and management (E/M) ... Read more
Keep Areas, Systems Separate for Accurate E/M Levels
Question: We are performing a voluntary self-audit of our evaluation and management (E/M) ... Read more
Reader Question:
Test Your Understanding of This Inclusive Dx
Question: We just got denied on a claim billed for strep and influenza A and B test using ... Read more
Test Your Understanding of This Inclusive Dx
Question: We just got denied on a claim billed for strep and influenza A and B test using ... Read more
You Be the Coder:
Follow This Advice, Calculate Risk Level With Confidence
Question: I'm trying to determine the level of risk in the following encounter: a patient ... Read more
Follow This Advice, Calculate Risk Level With Confidence
Question: I'm trying to determine the level of risk in the following encounter: a patient ... Read more
Practice Management:
Follow This Advice, Keep Your Practice's Future Bright
Bright Futures guidelines can benefit your practice while helping your patients. Now in i... Read more
Follow This Advice, Keep Your Practice's Future Bright
Bright Futures guidelines can benefit your practice while helping your patients. Now in i... Read more
Procedure Coding:
Answer These 4 Questions, Enhance Your Cerumen Removal Coding
Don't let familiarity with this common procedure breed contempt. Cerumen removal is one o... Read more
Answer These 4 Questions, Enhance Your Cerumen Removal Coding
Don't let familiarity with this common procedure breed contempt. Cerumen removal is one o... Read more
Mythbusters:
Bust These 4 Myths for Clear Respiratory Reporting
Don't let bundling, modifier use obstruct your documentation. With all their confusing te... Read more
Bust These 4 Myths for Clear Respiratory Reporting
Don't let bundling, modifier use obstruct your documentation. With all their confusing te... Read more
Reader Question:
Take Time to Report Travel Counseling Encounter
Question: One of our high-school-age patients is preparing for a monthlong trip to Kenya. ... Read more
Take Time to Report Travel Counseling Encounter
Question: One of our high-school-age patients is preparing for a monthlong trip to Kenya. ... Read more
Reader Question:
Separate Services, Mend This Modifier Mess
Question: We were denied payment on 99214-25, B07.8, and 17110 for removal of a verruca pl... Read more
Separate Services, Mend This Modifier Mess
Question: We were denied payment on 99214-25, B07.8, and 17110 for removal of a verruca pl... Read more
Reader Question:
Establish These Details for Clean Trach Tube Removal Documentation
Question: Our pediatrician recently changed a trach tube in our office. How should we bill... Read more
Establish These Details for Clean Trach Tube Removal Documentation
Question: Our pediatrician recently changed a trach tube in our office. How should we bill... Read more
You Be the Coder:
Dial in Location for Telemedicine Success
Question: We would like to start using telehealth in our pediatric practice — we think i... Read more
Dial in Location for Telemedicine Success
Question: We would like to start using telehealth in our pediatric practice — we think i... Read more
News You Can Use:
Know Which Peds Services CMS Devalued in 2019
Many commonly used codes will negatively impact this year's bottom line. As we reach the ... Read more
Know Which Peds Services CMS Devalued in 2019
Many commonly used codes will negatively impact this year's bottom line. As we reach the ... Read more
Guidelines:
Reduce Prolonged Coding Agony With These 4 Hints
Go beyond reporting time to claim additional service time successfully. You've probably c... Read more
Reduce Prolonged Coding Agony With These 4 Hints
Go beyond reporting time to claim additional service time successfully. You've probably c... Read more
ICD-10 Coding:
Take This Advice for Flawless Worried Well Coding
Hint: Knowing your encounter code options and ICD-10 guidelines pays. The scenario is all... Read more
Take This Advice for Flawless Worried Well Coding
Hint: Knowing your encounter code options and ICD-10 guidelines pays. The scenario is all... Read more
Reader Question:
Improve Your Coding Health with This New Flu Vaccine
Question: Our dietician reviews electronic food logs sent in remotely on a weekly or month... Read more
Improve Your Coding Health with This New Flu Vaccine
Question: Our dietician reviews electronic food logs sent in remotely on a weekly or month... Read more
Reader Question:
Assign Additional MDM Point Only if Supplemental Information Provided
Question: We recently took on a new patient who is deaf. The patient came with a family me... Read more
Assign Additional MDM Point Only if Supplemental Information Provided
Question: We recently took on a new patient who is deaf. The patient came with a family me... Read more
You Be the Coder:
Distinguish Distinct, Multiple Modifiers in This Separate Procedure Scenario
Question: Our provider administered an ear lavage to remove impacted cerumen in one o... Read more
Distinguish Distinct, Multiple Modifiers in This Separate Procedure Scenario
Question: Our provider administered an ear lavage to remove impacted cerumen in one o... Read more
ICD-10 Guidelines:
Let These 3 Tips Guide You to Accurate Neonate Dx
Hint: P-code guidelines, age provide the key. Using codes from ICD-10 Chapter 16: Certain... Read more
Let These 3 Tips Guide You to Accurate Neonate Dx
Hint: P-code guidelines, age provide the key. Using codes from ICD-10 Chapter 16: Certain... Read more
Coding Quiz:
Take This Quiz, Review Your ROS Knowledge
Let these answers provide you with the who, what, how, and why of system review recording.... Read more
Take This Quiz, Review Your ROS Knowledge
Let these answers provide you with the who, what, how, and why of system review recording.... Read more
Case Study Corner:
Code by the Numbers for HPV Vaccination Success
Know patient age, dose schedule for precision immunization coding. Since 2006, the preval... Read more
Code by the Numbers for HPV Vaccination Success
Know patient age, dose schedule for precision immunization coding. Since 2006, the preval... Read more
Coding Quiz Answers:
Check Your Answers to Our ROS Coding Quiz
Once you've answered the quiz questions on page 11, compare your answers with the ones pro... Read more
Check Your Answers to Our ROS Coding Quiz
Once you've answered the quiz questions on page 11, compare your answers with the ones pro... Read more
Reader Question:
Explore Modifier Use, E/M, When Foreign Body not Found
Question: Our pediatrician just saw a young patient who complained of a sliver in his fing... Read more
Explore Modifier Use, E/M, When Foreign Body not Found
Question: Our pediatrician just saw a young patient who complained of a sliver in his fing... Read more
Reader Question:
Documentation Key to Patient I&D
Question: Our provider recently drained an abscess on one of our patients. What documentat... Read more
Documentation Key to Patient I&D
Question: Our provider recently drained an abscess on one of our patients. What documentat... Read more
Reader Question:
Use This New Z Code for Maternal Depression Screens
Question: As a part of the Medicare Meaningful Use program, we routinely screen mothers of... Read more
Use This New Z Code for Maternal Depression Screens
Question: As a part of the Medicare Meaningful Use program, we routinely screen mothers of... Read more
You Be the Coder:
Know When Age Is, is Not, a Factor in This Immunization Encounter
Question: We have a physician in our practice who orders nurses to administer 90696 to kid... Read more
Know When Age Is, is Not, a Factor in This Immunization Encounter
Question: We have a physician in our practice who orders nurses to administer 90696 to kid... Read more
Mythbusters:
Bust These 3 Myths to Start the New Year Right
Know what to mark up, and what to leave alone, in your old coding books. Even though 2018... Read more
Bust These 3 Myths to Start the New Year Right
Know what to mark up, and what to leave alone, in your old coding books. Even though 2018... Read more
E/M Coding:
Add to Your Understanding of New vs. Established
The 3-year rule isn't the only guideline you need to apply. On the surface, if you know t... Read more
Add to Your Understanding of New vs. Established
The 3-year rule isn't the only guideline you need to apply. On the surface, if you know t... Read more
Condition Spotlight:
Got Lactation Service Questions? We've Got Answers
Provider credentials key to accurate billing. Giving Mom the best possible advice about b... Read more
Got Lactation Service Questions? We've Got Answers
Provider credentials key to accurate billing. Giving Mom the best possible advice about b... Read more
Reader Question:
Report Opened Vial Dose in This Vaccine Administration
Question: We did not have a children's dose of the flu vaccine in stock, so our provider a... Read more
Report Opened Vial Dose in This Vaccine Administration
Question: We did not have a children's dose of the flu vaccine in stock, so our provider a... Read more
Reader Question:
Modify Your Understanding of 'Distinct Service'
Question: We just got a denial from Blue Cross Blue Shield (BCBS) for using modifier 59 on... Read more
Modify Your Understanding of 'Distinct Service'
Question: We just got a denial from Blue Cross Blue Shield (BCBS) for using modifier 59 on... Read more
You Be the Coder:
Use Abnormal Finding Code With Mixed Well-Child Results
Question: Our provider saw a 6-year-old patient for a 99393 well-child check. At the encou... Read more
Use Abnormal Finding Code With Mixed Well-Child Results
Question: Our provider saw a 6-year-old patient for a 99393 well-child check. At the encou... Read more