Pediatric Coding Alert

1. If another physician or other appropriate source requests an opinion regarding a child's ADHD, you may consider coding the initial encounter as an E/M consultation in the 99241-99245 series (Office consultation for a new or established patient). School nurses and psychological counselors are appropriate sources under CPT guidelines . Remember, you must meet all the consultation coding and reporting guidelines.

2. Code the symptoms if the pediatrician is unsure of an ADHD diagnosis. In addition to the V codes, possible diagnosis codes might include 315.2 (Specific delays in development; other specific learning difficulties) or 312.00 (Undersocialized conduct disorder, aggressive type, unspecified). You should use as many diagnosis codes as apply to the case's complexity, coding consultants advise.

3. The first visit usually includes a lot of time spent counseling about ADHD effects, treatment, and impact on schooling. Therefore, coders can use the time component on an E/M visit if the counseling and/or coordination of care take up more than 50 percent of the total visit time.

For instance, if the physician spends 30 minutes with the patient, with half of that spent on counseling, report the visit as 99214 ( physicians typically spend 25 minutes face-to-face with the patient and/or family). Often, evaluations take longer, so report 99215 ( physicians typically spend 40 minutes face-to-face with the patient and/or family). In the latter case, the face-to-face visit must be at least 40 minutes with half the time spent counseling. Documentation of time spent is critical in these cases.