Pediatric Coding Alert
Have Policyholders Check 99381, 99391 Coverage
Question: Is there a limit or a set criteria for how many preventive visits can be billed for an infant until age 1 using 99381 or 99391? Online Subscriber Answer: CPT contains no frequency limitations on how many times you can report 99381 (Initial comprehensive preventive medicine evaluation 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 patient; infant [age younger than 1 year]) and 99391 (Periodic comprehensive preventive medicine reevaluation and management of an individual ...) for a patient during his first year. Insurers, however, may only cover a designated number of preventive medicine services in a given year. To avoid problems with noncovered service payment, you may want to have an office policy that notifies patients of how many preventive medicine visits you recommend in the first year and advises parents to check their policy's individual allowances. For instance, the Bright Futures Guidelines, which are age-appropriate and evidence-informed periodicity recommendations created by the American Academy of Pediatrics, recommend preventive medicine services at 3-5 days of age, by 1 month, and at 2, 4, 6, and 9 months of age, which equals six first year preventive medicine services. Note: The 3-5 day visit can often be linked to a problem diagnosis (jaundice [such as 774.30], weight loss, feeding problems [779.3]) and coded with 99201-99215 (Office or Other Outpatient Services). This removes it from the restricted number of preventive medicine visits allowed in the first year. If a patient's insurer covers fewer visits, inform parents that they will be responsible for the charges. You may want to have them sign a private payer version of Medicare's advance beneficiary notice (ABN) indicating that they are aware of this financial responsibility and still choose to have and pay for the service. Bonus: For a ready-to-go form, e-mail the editor at jenniferg@eliresearch.com with subject line "PP ABN".
Pediatric Coding Alert
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Have Policyholders Check 99381, 99391 Coverage
Question: Is there a limit or a set criteria for how many preventive visits can [...] - READER QUESTIONS:
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Question: Does a certified nurse specialist (CNS) count as a nurse practitioner (NP) for reporting [...] - READER QUESTIONS:
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Asthmatic Croup Versus Regular Croup
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Use 82272 When Child Needs Hemocult Test
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Check Treatment Before Reporting Splinting
Question: A 3-year-old child comes in with a history of falling off a chair and [...]
