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Pediatric Coding Alert

You Be the Coder:

Know the Ropes for Reporting Sick Evaluation During Well Visit

Published on Fri Jan 13, 2012

Question: When parents present with infants for regular health checkups at two, four, and six months, I spend a lot of time counseling and treating colic and GE reflux. Can I report 99212-25 with the ICD-9 code for colic (789.7) or gastroesophageal reflux (530.81) along with 99391 (linked to ICD-9 code v20.2 for a well baby visit)?Tennessee SubscriberAnswer: According to CPT, you can bill a sick visit (Office or other outpatient services codes 99212-99215) in addition to a previously scheduled preventive medicine service (99381-99385 and 99391-99395) if the presenting problem "is significant enough to require additional work to perform the key components of a problem-oriented E/M service" and modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is attached.As with any E/M service, the severity of the diagnosis, intensity of medical decision-making and time spent on [...]
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