Pediatric Coding Alert

Bonus: You can charge a separate E/M service in addition to these surgeries

Summer may open your schedule to providing some often-overlooked minor procedures that have their own CPT codes.

"Pediatricians can get stuck in a rut of providing the same type of services and always using E/M codes for them," says Victoria S. Jackson, administrator at Southern Orange County Pediatric Association in Lake Forest, Calif. You can generate more revenue if you report procedure codes for these five items:

1. Code Nursemaid Elbow Treatment as CPT 24640

You can code for the treatment of nursemaid elbow with 24640 (Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation). Pedia-tricians usually report an E/M service in addition to the treatment, says Paula Jacob, CPC, coding compliance manager at Medical Clinic of N. Texas.

Why: The pediatrician doesn't just pop the radial head subluxation into place. He has to take a history, examine the patient and then make the medical decision to treat the injury, Jacob says.

"To indicate a significant and separate E/M, you append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the service code (such as 99212-99213, Office or other outpatient visit for the evaluation and management of an established patient ...)," she says.

2. Use Repair Code for Laceration

When a pediatrician closes a simple skin wound, insurers will reimburse over $145 for the repair. The catch is you have to use the appropriate closure code, such as 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) which the National Physician Fee Schedule pays at $145.53, or 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) which reimburses $153.86.

Once again, you should report an office visit code along with the wound repair code, if the pediatrician performs a significant and separate E/M service. "You would use modifier 25 as long as the procedure doesn't contain a 90-day global period," Jacob says.

Remember: You should count wound closure using Dermabond as suturing. But you should include a Steri-strips repair in the E/M service.

3. Assign 90788 for Antibiotic Injection

If a sick child requires a therapeutic injection, you should code for the administration with 90788 (Intramuscular injection of antibiotic [specify]). "For instance, to avoid hospitalizing a patient who has pneumonia (such as 486, Pneumonia, organism unspecified), a pediatrician orders a Rocephin shot. You would report 90788, plus J0696 (Injection, ceftriaxone sodium, per 250 mg)," Jackson says.

Tip: You should charge an office visit (such as 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) in addition to the injection administration. "Giving the shot is not part of the E/M," Jackson says.

4. Bill Catheterization With 51701

Urine catheterization (51701) is another high-paying procedure that pediatricians often forget to code separately. "Our nurses usually do the catheterization, which reimburses around $107," Jackson says.

You should code a urine catheterization with 51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]). To get payment for the E/M that led to the decision for surgery, make sure to link the signs or symptoms, such as fever (780.6), to the E/M, and link the definitive diagnosis (such as urinary tract infection, 599.0, Urinary tract infection, site not specified), to the catheterization.

Bonus: If a nurse performs the catheterization, you may charge for the procedure, if the physician directly supervises the nurse. In other words, the pediatrician must be in the office suite.

5. Report Cerumen Impaction Removal Plus Separate E/M Dx

An established patient presents with signs of an upper respiratory infection and impacted cerumen that the pediatrician has to remove. If you code just 99212-99215, you could be missing out on an additional $57 - 69210's approximate going rate.

Lesson learned: Report cerumen removal (69210, Removal impacted cerumen [separate procedure], one or both ears) in addition to a significant, separately identifiable service. Your ICD-9 codes will help you decide whether to code the E/M. "You must have different diagnoses," says Wanda L. Turner, CPC, coding specialist at Pediatric Associates of Fairfield in Fairfield, Ohio. Otherwise, payers will include the E/M with the cerumen removal.

For instance, a child has a bulging ear drum, but an impaction prevents the pediatrician from examining the ear drum. You would link the cerumen removal (69210) to the impacted cerumen diagnosis (380.4, Impacted cerumen) and the office visit (99212-99215 with modifier 25) to the middle ear-related diagnosis, such as otitis media (382.00, Acute suppurative otitis media without spontaneous rupture of ear drum), Turner says.