Pediatric Coding Alert

V code, time, 99211, 90862, and modifier 25 could all come into play -- here's when.Wonder if you're losing $8 to $90 on office visits for attention deficit hyperactivity disorder (ADHD) rechecks? Make sure you're collecting all your deserved reimbursement with this easy step-by-step guide.Step 1: Relegate V Code to Position 2Have you ever reported V58.69 (Long-term [current] use of other medications) on ADHD medication checks only to have payers kick out the claims, which could cost $90 for a 99214? (For payment calculation, see note in step 2.) "In 'Coding Guidelines,' V58.69 is only a secondary code," explains Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine, Department of Pediatrics at Children's Healthcare of Atlanta at Egleston. ICD-9 stipulates that you must first code another diagnosis with V58.69, such as the reason for the medication. You can use V58.69 if the visit's purpose is monitoring the long-term use of [high risk] medication (not otherwise listed), Linzer says. ICD-9 does not define what a high-risk medication is. Example: You provide a medication check for possible physical side effects to Ritalin for ADHD. If the visit's purpose is to monitor the Ritalin that the child is taking for ADHD, you would code 314.01 (Attention deficit disorder; with hyperactivity) as the primary diagnosis and then V58.69 as the secondary diagnosis, Linzer instructs.Step 2: Consider Selecting Level Based on TimeWhen a patient comes in for follow up ADHD checks, you can use time as the controlling factor to select the office visit level when you spend more than 50 percent of the total face-to-face encounter time on counseling and/or coordinating care. Documentation must indicate the visit's total face-to-face time, the time spent counseling and/or coordinating care, and the topics discussed. "I typically code these visits as 99212s (Office or other outpatient visit for the evaluation and management of an established patient ... Physicians typically spend 10 minutes face-to-face with the patient and/or family) every three months,"- or 99213s (... Physicians typically spend 15 minutes face-to-face with the patient and/or family), depending on time, reports Richard Lander, MD, FAAP, a pediatrician at Essex-Morris Pediatric Group in Livingston, N.J.Reason: Follow-up ADHD visits often involve extensive discussions on school issues, home behavioral problems, diet, and sleep concerns related to medication, says Richard Tuck, MD, FAAP, a pediatrician with PrimeCare of Southeastern Ohio in Zanesville. The total face-to-face time spent on counseling and coordination of care in these counseling dominated encounters could easily justify 99213. If there is significant appetite or weight loss or sleep concerns, a visit could even be a 99214 (... Physicians typically spend 25 minutes face-to-face with the patient and/or [...]