Wiki PEDS -Well child visit vs Nutrition or Physical Activity

[KoBee]

Getting a bit confused on what is included in a well child visit and was it not, our peds providers have template with specific well child assessments. They mentioned they should be coding and billing separate codes aside from preventive visit. Is this sufficient to bill nutrition and physical activity counseling codes? or would this just be part of the preventive visit?

Nutrition: Discussed nutrition and provided counseling on well-balanced diet.
Physical activity: Discussed the importance of physical activity on a routine basis.
Dental: Discussed dental hygiene with family.
Elimination: Patient is voiding and stooling habits are normal.
Behavioral: Disciplinary methods discussed and reviewed age appropriate behavior.
Sleep: Reviewed sleep hygiene.
Safety: Counsel provided for age appropriate safety measures.
School: Discussed school with patient and family.
Social: Discussed importance of appropriate socialization.


appreciate any help

 

[Cynthia Hughes]

Hi. The physicians and other providers may be referring to codes that signify that HEDIS measures have been met. For example, many plans include codes like Z71.82 (exercise counseling) and Z71.3 (dietary counseling and surveillance) in their guidance for coding to support HEDIS. Other HEDIS measures are supported by CPT codes (eg, lead screening test 83655 or codes for immunization products and administration).

As indicated in CPT, the codes for preventive medicine E/M services do not include immunizations, screening tests (eg, vision, hearing, developmental screening), or any significant work to address a problem. Codes for these services are separately reported though some payers will bundle the services.

Hope that is helpful.
Cindy

 

[KoBee]

Hi. The physicians and other providers may be referring to codes that signify that HEDIS measures have been met. For example, many plans include codes like Z71.82 (exercise counseling) and Z71.3 (dietary counseling and surveillance) in their guidance for coding to support HEDIS. Other HEDIS measures are supported by CPT codes (eg, lead screening test 83655 or codes for immunization products and administration).

As indicated in CPT, the codes for preventive medicine E/M services do not include immunizations, screening tests (eg, vision, hearing, developmental screening), or any significant work to address a problem. Codes for these services are separately reported though some payers will bundle the services.

Hope that is helpful.
Cindy

I see, I think i understand, please correct me, so we don't really need another CPT on what i share that our providers are documenting but more on the diagnosis should be reported on the claim if this were for HEDIS measures to account for nutrition and physical activity counseling, correct? unless there was more anticipatory guidance and counseling or referral and/or deeper detail discussion of nutritional behaviors and give education materials/handouts and along with weight/obesity counseling if needed. Then other services can be reported separately.

 

[Cynthia Hughes]

I see, I think i understand, please correct me, so we don't really need another CPT on what i share that our providers are documenting but more on the diagnosis should be reported on the claim if this were for HEDIS measures to account for nutrition and physical activity counseling, correct? unless there was more anticipatory guidance and counseling or referral and/or deeper detail discussion of nutritional behaviors and give education materials/handouts and along with weight/obesity counseling if needed. Then other services can be reported separately.

Yes, using the diagnosis codes adds context of the anticipatory guidance provided that supports the HEDIS measures. Counseling becomes separately reportable only when a problem is addressed (eg, obesity with elevated blood pressure) and that work is significant and separately identifiable from the anticipatory counseling of the preventive service.

Cindy

diagnosis codes, diagnosis coding