Pediatric Coding Alert

Question: When an asthma patient comes in for a checkup, should I code a sick visit or preventive medicine services?

Ohio Subscriber

Answer: If preventive medicine services are provided, use 99381-99395. Coding a sick visit (99201-99215) in addition depends on the asthma service rendered, which depends on the child's condition.
 
For example, if a child with controlled asthma who uses medication when necessary and requires no medication change comes in for a well visit, do not code an office visit in addition to the well visit. However, if the child requires a medication change due to height or weight gain and a new prescription is written, bill an office visit with modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) appended, plus the preventive services visit. Link V20.2 (Health supervision of infant or child; routine infant or child healthcare) to the preventive medicine service, and 493.00 (Asthma; extrinsic asthma; without mention of status asthmaticus or acute exacerbation or unspecified) to the office visit.
 
If a child who has been seen often during the year for asthma episodes comes in for a well visit, a lot of time may be required to evaluate the asthma. Because this is above what you would do during a well visit, bill an office visit also. Link V20.2 to the preventive medicine service, and 493.00 to the office visit.
 
If a child comes in for a well visit and is having an asthma attack at the time a rather unusual circumstance, as the parent is not likely to wait in such a case you might reschedule the well visit and bill an office visit only.