Pediatric Coding Alert
Prolonged Service or Level-5 Visit?
Question: An established 9-year-old patient undergoing treatment for a urinary tract infection (599.0) reported to the office for a urinalysis to gauge her recovery progress. In addition to performing the test, the pediatrician discussed the patient's condition with her parents for 20 minutes. The visit was a level-three E/M service that lasted a total of 45 minutes. How should I report this? -- Information for Reader Question and You Be the Expert provided by Richard H. Tuck, MD, FAAP, medical director of Quality Care Partners in Zanesville, Ohio.
California Subscriber
Answer: Report CPT 99213 (Office or other outpatient visit for the evaluation and management of an established patient ... ) with +99354 (Prolonged physician service in the office or other outpatient setting ... ; first hour).
Also report 81000 (Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy) for the urinalysis. Less than 50 percent of the visit was spent on counseling, so you cannot upcode to a level-five visit (99215) in this case.
Pediatric Coding Alert
- 4 Tips Improve Your 51701 Encounter Pay
Combat E/M and catheterization denials with documentation, diagnoses and modifier
When billing for office visits that [...] - Case Study:
How to Recoup an Extra $200 In Precatheterization Services
Look for these 3 E/M-related billing possibilities You can improve your catheterization encounter pay if [...] - You Be The Coder:
Ring Removal
Question: A boy comes into our office with a ring stuck on his finger. The [...] - Destroy This Myth:
You May Use V20.2 as a 'Catchall' Vaccine Diagnosis
4 reasons to assign a specific ICD-9 code for each immunization Should you save yourself [...] - How to Score 100 on Immunization Diagnostic Coding
Clip and save your guide to billing 20 pediatric vaccines - Reader Question:
Clever Way You Can Report No Current Problem
Question: A nurse performs a weight and color check on a newborn whom the pediatrician [...] - Reader Question:
Don't Use Units With Allergy Injections
Question: For multiple allergy injections in which the patient brings in the serum, I report [...] - Reader Question:
2 Methods Improve Your Protime Coding
Question: How should I code for monitoring Protime when the patient has gone to the [...] - Reader Question:
Check Payer Policy for OV With PE Billing
Question: A 14-year-old presented for an annual physical. During the preventive exam, the mother mentioned [...] - Punch Up Your E/M Claims With Prolonged Service Codes
Account for extra service time with add-on codes
If your pediatrics practice isn't using prolonged service [...] - You Be The Expert:
Prolonged Service or Level-5 Visit?
Question: An established 9-year-old patient undergoing treatment for a urinary tract infection (599.0) reported to [...] - Code for Non-'Face-to-Face' Prolonged Service, Too
Experts report uneven reimbursement for the code set
Prolonged service codes are most often used for [...] - Reader Question:
Append Modifier -21 Only to Level-5 E/M Codes
Question: Since there are no prolonged service codes for under 30 minutes of extra E/M [...]
