Pediatric Coding Alert

At last months Pediatric Coding & Management Survival Strategies conference, sponsored by the publisher of Pediatric Coding Alert (PCA), held in Naples, FL, Victoria Jackson, administrator and CEO of Southern Orange County Pediatric Associates, seven-pediatrician, six-nurse practitioner practice in Lake Forest, CA, shared some of her experiences in pediatric practice reimbursement. Here are some of the coding tips Jackson, who is also the Legislative Liaison to the Primary Care Assembly of the Medical Group Management Association (MGMA), shared with attendees of the conference:

1. After-hours codes. These codes can bring in extra money, and should be used, Jackson urges. Insurance companies dont balk at all about paying for these, Jackson has found. These codes (99050, after hours; 99052, 10:00 p.m. to 8:00 a.m.; and 99054, Sundays and holidays) are only to be used when you see patients during times that you do not have regular office hours with set appointments, Jackson explains. Since pediatricians frequently work latescheduled patients have gotten backed up and the staff needs to stay an hour or so to get everyone seenmany people wonder if they can use 99050. The answer is they cant use it for a patient who was scheduled, say, for 4:30, and isnt seen until 5:30even if the offices posted hours are 9 a.m. to 5 p.m. If, however, the visit is a walk-in, and the pediatrician is just about to leave the office, you can bill an after-hours code, says Jackson.

Our office is open from 8:30 a.m. to 6 p.m. Monday through Friday, she relates. If the doctor is finished for the day at 6 p.m., and an emergency patient walks in, I would charge after hours. On Saturday and Sunday, there are no regularly scheduled patients at all (even though the office is technically open from 9 to noon)these visits are on a first-come, first-served basis, and are basically all walk-in emergency visits, explains Jackson. So I always use after-hours codes on weekends.

Note: Use code 99050 for Saturday and 99054 for Sunday.

2. Hospital admissions and ED visits on same day. You cant charge for a visit to the patient in the emergency department and a hospital admission (99221-99223) on the same daysomething that happens frequently in pediatrics. But you can raise the level of the hospital admission to account for your work in the ED, says Jackson. For example, if you were going to charge a CPT 99221 , you might raise it to a 99222 with documentation that supports a comprehensive history and exam and requiring a moderate level of decision-making.

3. Charge for records. Jacksons office doesnt charge for the first immunization record, or for filling out the form when the patient is there. But if the parent loses it, we charge them, says Jackson. We charge for camp forms, insurance forms, and sports forms, she says. We also charge parents if they want copies of the patients chart for themselves, but we dont charge them for sending it to another doctor. If the school requires a record of immunizations in order for the child to attend, the practice does not charge either.

Editors Note: Some of the practices we talked to charge their patients $5 per form.

4. Bill for home care planning. Often a newborn is having phototherapy at home, or a child is getting an intravenous infusion at home. You should bill for the doctors time spent coordinating this with code 99374 or 99375, says Jackson. These codes are for the supervision of a patient under the care of a home health agency (99374, 15 to 29 minutes; 99375, 30 minutes or more). These codes are filed once per month, so the pediatrician needs to keep track of the minutes in the chart. The doctor has to call the home health-care agency, follow up on the lab tests, and work on the treatment plan, says Jackson. Too many pediatricians dont bill for the time spent doing this, and they should, she adds.