Pediatric Coding Alert

Select the appropriate code based on the documentation--not the specialty or diagnosis. When it comes to an immunization or a urinalysis, you may know the standard codes for each service by heart. When you're evaluating codes for an E/M service, however, the issue isn't so clear-cut. Consider this question submitted to Pediatric Coding Alert from a subscriber: "Which code should we report for evaluation of a cough, runny nose, and fever? We can't decide whether it should be 99212 or 99213--but the pediatrician actually marked 99214." This question supports a common myth--that each type of diagnosis has a standard E/M code associated with it. However, your E/M code should be based upon what the documentation supports, which can differ greatly even with the same diagnosis. A cough, runny nose, and fever patient may have other chronic conditions, taking the complexity quite high--or he may simply have a common cold, which [...]