Pediatric Coding Alert

Ethically boost assessment visits by $61 when you find this documentation You can capture the initial service and ongoing visits for attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), if you code based on this coding continuum of care.

Diagnosis, maintenance, interval checks and reassessment of ADD/ADHD can be nurse-only, brief, or involved-physician visits. Here's your guide to keep the visit types straight and to avoid overlooking ethically deserved payments for these time-consuming encounters. Code Diagnosis Visit as 99215 or 99244 When the pediatrician diagnoses a patient with ADD (314.00, Attention deficit disorder; without mention of hyperactivity) or ADHD (314.01, ... with hyperactivity), you're going to be looking at a high-level E/M service. "You're probably going to be at 99215 (Office visit for the evaluation and management of an established patient ... physicians typically spend 40 minutes face-to-face with the patient and/or family), based on time," says Richard Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio. Counseling and/or coordination of care must comprise the majority of the face-to-face encounter to use time as the controlling factor when selecting this high-level of E/M service.

Tip: Because counseling is usually a predominant component of ADD/ADHD initial diagnosis sessions, anticipate using time to code these encounters, which usually take an hour. Encourage the physician to document the counseling session's content, the total face-to-face time spent, and the time devoted to counseling/coordinating care related to the ADD/ADHD disorder.

Don't overlook: If a school nurse or teacher asked for the pediatrician's opinion on the child, and the physician sends a report to the requesting source, you can report the visit as a consultation if the physician performs and documents the other requirements of this service. "These codes pay significantly more than a comparable office visit," says Stephen R. Levinson, MD, author of the AMA's Practical E/M: Documentation and Coding Solutions for Quality Health Care.

Having documentation that shows a counseling-based session of an hour, the time pediatricians usually spend on an ADD/ADHD initial assessment session, can add more than $60 to payment for the first diagnosis session. So if documentation supports a counseling-dominated consultation lasting one hour, you can report 99244 (Office
consultation for a new or established patient ... physicians typically spend 60 minutes face-to-face with the patient and/or family), which has a time allotment of an hour.

The 2007 Medicare Physician Fee Schedule pays 99215 a national rate of $129.60 (3.42 transitional non-facility total relative value units) compared to $191 for 99244 (5.04 RVUs). That equates to a difference of $61.40. Before choosing a consultation code for the visit, make sure you meet the service's requirements (see November 2006 Pediatric Coding Alert "Before You Code Another Consult, Look for These New Criteria"). Report [...]