Pediatric Coding Alert
Keep Coding When $$$ Don't Roll In
Question: When an insurance carrier does not pay for a code, should we still report it?
Virginia Subscriber
Answer: Yes. You should still code for what the pediatrician does. Proper records can help you in many arenas. CPT codes establish an information flow for the services pediatricians provide. Many carriers keep annual CPT code frequency data, and they often base payment on a procedure or service's frequency.
If you do not use a code because insurers do not pay for it, you will be unable to prove the need for that code's payment. Further, you can use this data in contract negotiations to show insurers the value of that code and of your services. You can also substantiate financial loss due to nonpayment of that procedure or service.
Pediatric Coding Alert
- Obtain Elusive Screening Payment With These Methods
Which item is your well-check inclusion appeal pack missing?
Before you throw in the towel on [...] - Avoid Using 'Loophole' to Bill Routine OMs as 99214s
Surprise! CPT and CMS require medical necessity for all E/M visits
If you fall for the [...] - You Be the Coder:
Code Tooth Decay Preventive Service
Question: Our pediatricians are considering offering in-office fluoride treatments as an added service. How would [...] - Clarification:
Check Law Before Extending Traditional MD-Only Codes
CPT doesn't offer the final word
The Reader Question "NPs Can Use MD Codes" in [...] - READER QUESTIONS:
Stick With 075 for EBV
Question: Should I code Epstein-Barr with new 2008 code 058.89 (Other human herpesvirus infection)?
Ohio Subscriber
[...] - READER QUESTIONS:
Photoscreening Gets Category I Code
Question: I'm questioning our practice's use of 92015 for photoscreening. The procedure doesn't seem to [...] - READER QUESTIONS:
Keep Coding When $$$ Don't Roll In
Question: When an insurance carrier does not pay for a code, should we still report [...] - READER QUESTIONS:
3 Ways to Code Suture Removal
Question: For suture removal, we found 15851. When a pediatrician removes sutures in the office [...] - READER QUESTIONS:
Are Consult Requests Limited to MDs?
Question: A school nurse or teacher asks a pediatrician for an opinion on a child, [...] - READER QUESTIONS:
Does 90634 + 90471 Require 51?
Question: Can you settle a dispute our office is having? Do we need to use [...] - READER QUESTIONS:
Update Hospital Bladder Aspiration Code
Question: A pediatrician performs a suprapubic aspiration to obtain a clean urine specimen from an [...]
