Wiki Using 99499 for siblings

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mollymurray

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I have a provider in a peds office who is asking about whether or not we can bill for this scenario, since we encounter it frequently: A parent brings in 1 of their 3 children to the office and the patient is diagnosed with lice, scabies, flu, etc. The parent tells the doctor that the two siblings at home are experiencing the same symptoms, so the doctor prescribes medication for the siblings not in the office.

If the provider documents the symptoms based on what the parents describe the other kids have, can we bill this along with the office visit for the sibling that we did see? For example, a 99213 and a 99499-25? Or is there a code that would be better suited to bill this? I appreciate any feedback you can give! Thanks.
 
99499

Who are you billing the 99499 under? Are you billing it under the patient that was seen or the siblings at home? Also are you sending the claims into insurance?
 
We have not billed anything yet, it is just something that the doctors are asking if we could bill. If we did bill it, I think we would have to bill it under the siblings at home on a new claim and sending it to insurance. They are already documenting all of the siblings symptoms under their charts so that they can prescribe the Rxs. I'm just wondering if this is even billable since there is no face to face interaction with the children, only the family.
 
I have a question that's somewhat related to this, but how does one code a prophylactic medication requirement if the other siblings aren't sick yet but one is. Example Whooping Cough?
 
Ben I am thinking a V code for prophylactic treatment. But if the child being treated is not in the office for exam, I think it is bad practice to charge a visit for it. Some things are just good medicine in my opinion.
 
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