Pediatric Coding Alert

Outside this time frame, consider filling out forms with well check.

Summer vacation is right around the corner, and you know what that means: Parents needing camp forms filled out, and your practice wanting to provide this service while getting paid for the pediatricians time.

Heres how your peers do it: 100 percent* complete the form without a face-to-face encounter.

Note: Figure based on respondents to a survey posted on www.PediatricCoding911.com, not a scientific sampling.

But doing so comes with some hitches and additional options.

Tie Exam Into Preventive Medicine Service

Why is capturing pay for camp form services, which generally do not require the work involved in a preventive medicine exam (99381-99395, Preventive Medicine Services), problematic? There is no code for a camp physical exam, writes Richard Lander, MD, FAAP, pediatrician with Essex-Morris Pediatric Group in Livingston, N.J.

You can build the associated E/M service into forms completion for attending summer camp or playing summer sports. We try to tie the sports exam into the patients preventive medicine service, said Julia M. Pillsbury, DO, FAAP, FACOP, in Give Your Preventive and Vaccine Services a Checkup at The Coding Institutes Pediatric Coding and Reimbursement Conference 2009 in Las Vegas.

When you fill out a camp form at the time of an E/M service such as a preventive medicine service, the forms completion is typically considered included in the E/M service (for instance, 99394, Periodic comprehensive preventive medicine reevaluation and management of an individual & adolescent [age 12 through 17 years]).

Complete Form for Recently Performed Annual

If youve already given the camp wanabee her preventive medicine service, you might not have to have her come into the office. A patient has to have had a well visit exam within 12 months for us to fill out a form, Lander reports.

Heres another offices timeframe. If the camp form requires a visit within two years, we do not require another visit if the patients checkup falls within that time frame, notes Marc Tanenbaum, MD, FAAP, a pediatrician with Pediatrics and Adolescent Medicine in Atlanta.

Tanenbaum and his partners, however, add a clarification that as per the date of their checkup the patient is clear for participation and camp activities, so as not to imply that certification is per the date of signing the form.

Dismiss Forms Code, Consider Charge

Check how other practices in your area handle filling out camp forms without face-to-face encounters. If they consider the service a freebie, you might have to, too. In some areas, a nominal charge is the normal practice.

If the patient has had a physical, we complete the form without charge, says Nancy Bishoff, MD, FAAP, a private practice pediatrician in Lexington, Ky. We do let the parent know up front that there is a 24 hour turnaround time to get the form completed.

When doing a forms charge, your best bet is to use an internal code. The special reports code (99080, Special reports such as insurance forms, more than the usual information conveyed in the usual medical communications of standard reporting form) is for completing forms that involve more work than that usually required for a standard insurance form. Camp forms are typically no more involved than a standard medical form, notes Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville.

Watch out: Insurance companies consider filling out forms that are not done at the time of an E/M visit a noncovered service, and families would be responsible for full payment. Two New Jersey pediatric practices report that they charge a designated fee for these forms. A Southern group charges an Administrative Service Fee per calendar year. If a parent needs the form on the same day she requests the service, an additional charge may apply.

Thinking of changing your practices forms policy -- for instance, charging an additional fee for same day requested services? Be sure to notify your patients in advance.

Revert to Office Visit When Exam Needed

If a patients preventive medicine service is outside the allowed timeframe, but theyre not due for another annual, code the camp exam based on the performed and documented history, exam, and medical decision making (HEM). If the camp requires another physical, then the patient is charged directly for an office visit (99201-99215 with V70.3, Other medical examination for administrative purposes), Landers notes.

Dr. Tanenbaum concurs: Beyond a two-year interval, we are not comfortable with signing the form without a face-to-face encounter, be it a preventive medicine service or an office visit service.