Wiki Urgent help needed = well exams

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sluke9

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Does anyone have any resources other than aap website that would give a good description of what should be done during a well child exam?
1) Doctor trying to bill for E/M on well exams. Generally he is only noting that there is another condition but nothing is significant to allow separate E/M for it.
2) Doctors are trying to bill 96110 on every well child exam. He says this is done but there is no questionaire filled out, no testing documenation or report is done. He's billing it on newborns/infants too.
I need to be able to show what is included in well exam and why separate visit isn't warranted in most cases. Most importantly why 96110 isn't appropriate for newborns/infants.
Any help is appreciated! Thanks
 
Check your carriers' Provider Manuals (eg, BCBS and Medicaid) for directions for what should be included in the wellness/preventive exams.

1) Ask Doctor to point out the documentation of the E/M, and also review the CPT guidelines for the Preventive Services, ??if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service,??

2) Billing 96110 - The 2014 CPT description clearly states, "...with interpretation and report, per standardized instrument form."
The 2015 CPT description is revised to include, "...(eg, develpmental milesonte survey, speech and language delay screen), with scoring and...."

Some commonly used developmental screening instruments that are coded as 96110 include:
▪ Ages and Stages Questionnaire (ASQ) and Ages and States Questionnaire: Social and Emotional (ASQ:SE)
▪ Child Development Review
▪ Parents? Evaluation of Development Status (PEDS).
 
sounds like you have trouble. have your provider purchase aap's "Coding for Pediatrics". all your answers are in there. bonus for you, free ceu's for you by completing test in the book. lburke cpedc
 
Can I just tag on along with this? I am having trouble getting the elements for a seperate E/M when a preventive visit is done and something is actually treated. For example....

Mom says baby has been fussy and I can get 3 HPI elements for History. On exam the provider checks the ears and finds acute otits media and orders Rx.

Now I have Problem Focused History because all I have is 3 HPI and nothing extra in ROS or PFSH. That information is inline with the preventive visit. Then I have nothing with the exam because nothing extra is done outside of the preventive exam. For MDM I have Moderate for New Problem/Rx. So I have a 99212 with the preventive.

Now if there is no complaint and the provider finds an ear infection and prescribes for it I don't have History or Exam for a seperate E/M, only MDM.

So I'm having a hard time getting anything more than a 99212 due to the limited "additional" History or Exam outside of the preventive. Even if something more is done, the most I can get is Problem Focused for these two and so 99212 regardless of the MDM.

Am I on the right track or are you finding SUPPORTING information for more?
 
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