Pediatric Coding Alert

Answer: There is no problem with your office providing both services to your patients at the same time providing you follow the following coding and billing guidelines.

In addition to billing the appropriate, age-specific wellness visit code from 99381-99397 (Initial/periodic comprehensive preventive medicine evaluation/reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/ anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new/established patient …), you will bill either 99188 (Application of topical fluoride varnish by a physician or other qualified health care professional) or D1206 (Topical application of fluoride varnish) if your provider is a part of the Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program.

No modifiers are needed on either the wellness evaluation and management (E/M) or the fluoride service.

Coding alert: If you do bill 99188, remember to document that a physician or other qualified health care professional (QHP) applied the treatment to the patient. And remember to add Z29.3 (Encounter for prophylactic fluoride administration) as the diagnosis code for the service.