Wiki Billing for PE's in the first 0-28 days

[ljhaley@gmail.com]

Hello! In my office we follow a rule of doing
ONE PE 99391 /V20.31 for the first 0-7 days, and
ONE PE 99391/V20.32 for the 8-28 days
Followed by 99391/V20.2 for 6-8 weeks. QUESTION: I have a provider who wants to know if they can bill MORE than ONE 99391 in the 8-28 day period using V20.32. I have never heard of this and told them if the child has an issue just do a regular E&M (99213-99214)and code with the issue for diagnosis. I can't find a good reference that spells out they only get one PE during the 0-7 day time period and the 8-28 day time period- Any Suggestions? THANK YOU!

 

[Biller385]

The insurance usually will tell you how many well checks they will pay the the child. Check with the insurance companies.

Cathy

 

[bwolfe1]

Would you code that first visit with 99381 instead of 99391?

 

[ljhaley@gmail.com]

to answer bwolfe1 We see the child in the hospital so we cannot bill 99381 (new pt)because the baby is already established with us, it would be a 99391.
I was looking for something from the CPT manual, or Professional Societies AMA, AAFP, etc to solve this once and for all. (Biller385 thank you for the suggestion but we deal with many Payors, all have different protocols for PE's most outside of the newborn period.) I'm looking for what would be the medical necessity of doing more than one PE in the 8-28 day time period. If the child has an issue/problem the doc can just bill a regular E&M to address it, not a PE. Thanks!