Pediatric Coding Alert

Question: Earlier this year, we saw a patient for splinter removal of the hand, which we coded as a foreign body removal (FBR). The mother is now bringing the patient in for an office visit for evaluation of a problem. Because we have done FBR on the patient, should I use an established patient code or do I bill a new patient code since the patient was never seen for an office visit?

Answer: You should use an established patient code (99212-99215, Office or other outpatient services). CPT's new and established patient guidelines rule depend only on whether the physician (or a same specialty partner in the same group) has provided faceto-face services or procedures to the patient in the past three years. Non face-to-face services such as reviewing lab reports and evaluating x-rays do not count toward the rule, but a face to-face procedure such as FBR of the hand (10120, Incision and removal of foreign body, subcutaneous tissues; simple) does.

By the way, make sure you are checking if a medically necessary significant separately identifiable evaluation and management was performed and documented prior to procedures your physicians are providing. Coding a procedure does not automatically eliminate coding an E/M-25 (modifier 25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) service.