Pediatric Coding Alert

Question: Our pediatrician is part of a team of professionals treating an eight-month-old patient with a swallowing disorder that prevents the child from taking in enough breast milk. We submitted our physician's charges for his E/M services forthis patient to Aetna but the claims manager keeps asking for additional documentation. Should we keep sending it, or should we append a modifier of some sort to get this claim moving and denote that we are part of a team treating this patient?Answer: Insurers often maintain comprehensive policies that describe the criteria you must meet when working as part of an interdisciplinary group, so your payer is most likely trying to ensure that you've met all of the requirements for treating the patient's swallowing disorder.According to Aetna's policy bulletin on pediatric intensive feeding programs (#0809), updated on Nov. 19, an interdisciplinary team can treat complex feeding/swallowing disorders in children and infants if [...]