Pediatric Coding Alert

Its called anticipatory guidance, and its an essential part of preventive care for children. The AAPs Health Supervision Guidelines III and the federal Health Care Financing Administrations program called Bright Futures includes counseling on safety issues.

Pediatricians need to do anticipatory guidance as part of preventive medicine in order to comply with the standards of the Academy, says Charles Schulte, MD, FAAP, president of the DC Chapter of the AAP and a pediatrician with Countryside Pediatrics in Sterling, VA.

But how can you get reimbursed for it? You need to use the appropriate E/M code for preventive services (99381-99385 and 99391-99395), responds Schulte. Because HCFA incorporated Bright Futures into the RBRVS, the value for preventive medicine is half a point higher to account for the extra time spent on counseling, says Schulte, who is also the AAPs advisor to the AMA CPT Editorial
Panel. Some commercial carriers have difficulty paying for preventive medicine. Nevertheless, Schulte recently persuaded some commercial carriers to sign contracts agreeing to pay for it, using the conversion factor specified by HCFA. For once the government has set this up correctly, says Schulte. But pediatricians wont get paid for providing these services unless they charge and code correctly.

However, preventive care codes usually work only once a year. So if you are doing this kind of counseling more often, you will probably have to use the office visit codes (99212 - 99215), choosing the level based on how much time it takes to do the counseling.

Note: Dont miss Optimal Office Visit Coding in an upcoming issue of PCA. Coding experts provide advice on when it is best to use each individual code, and how to keep accurate documentation.

Schulte notes that the pediatrician himself does not need to provide the anticipatory guidance -- it can be done by a staff member. However, if the patient only sees the nurse, regardless of the amount of time spent, you can only use the CPT 99211 office-visit code. Some face-to-face physician time is required to bill the preventive medicine codes and to receive a higher reimbursement.