Pediatric Coding Alert

Well checks involve many extras -- which one are you forgetting to code?If you're not clear on the associated services you can code outside a preventive medicine service, you could overlook charging many ancillary services."The American Academy of Pediatrics recently issued new age-appropriate preventive medicine guidelines," says Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville. The Bright Futures Guidelines recommend evidence-based periodicity for history, measurements, sensory screenings, developmental/behavioral screenings and procedures. Here's what you can capture in addition to the preventive medicine service code (99381-99385, New patient preventive medicine service; 99391-99395, Established patient preventive medicine service).Include History, Measurements, Exam in Well CheckYou take history and measurements at all preventive medicine services, except neonatal, "which are give-aways, pure and simple," says Herschel R. Lessin, MD, vice president and clinical research director at The Children's Medical Group in Poughkeepsie, N.Y. "The history and measurements are part of the preventive medicine code and cannot be billed separately."Exception: Your history uncovers a specific problem, Lessin says. In this case, you would need modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to bill a separately identified and documented E/M service (99201-99215, Office or other outpatient visit ...).Heads up: The added body mass index (BMI) recommendation starting at age 2 means you may report an additional ICD-9 code. Use the BMI percentile to choose the correct V85.5x code. For instance, you would represent a 3-year-old girl's 10 percent BMI with V85.52 (Body Mass Index, pediatric, 5th percentile to less than 85th percentile for age).Similarly, you would include the examination in the preventive medicine service.Code Out Sensory ScreeningsCPT does not include ancillary services and screenings in the preventive medicine service codes. Therefore, you should separately report any vision or hearing screening.Example: At a 6-year-old's established patient preventive medicine service, a nurse tests the child's vision with a Snellen wall chart and his hearing with a pure tone audiometer. The child passes both screens. You should report 99393 (Periodic comprehensive preventive medicine re-evaluation and management of an individual ... late childhood [age 5 through 11 years]), 99173 (Screening test of visual acuity, quantitative, bilateral) and 92551 (Screening test, pure tone, air only) with V20.2 (Routine infant or child health check).You should not, however, separately code the risk assessment, such as using informal questions to assess for vision or hearing problems, that the guidelines recommend providing at preventive medicine services, in which screenings aren't indicated. If your risk assessment resulted in a positive, meaning the child required screening, you would then code the appropriate sensory screening code.Report Standardized TestingThe guidelines break developmental assessment into two portions:1. Surveillance, which [...]