Pediatric Coding Alert
Get Paid for Newborn Circumcision and Hospital Visit on the Same Day
Managed cares latest curve ball to pediatricians is a refusal to pay for newborn circumcis... Read more
Managed cares latest curve ball to pediatricians is a refusal to pay for newborn circumcis... Read more
Jury Still Out on Rotavirus Reimbursement, AAP Advises Wait-and-See Approach
When the Food and Drug Administration licensed RotaShield earlier this year (August 31),... Read more
When the Food and Drug Administration licensed RotaShield earlier this year (August 31),... Read more
Use Higher Level Codes to Bill for Pre-Op Exams
In the October issue of PCA (pages 79-80), we discussed the problem of coding for pre-oper... Read more
In the October issue of PCA (pages 79-80), we discussed the problem of coding for pre-oper... Read more
Maximizing Reimbursement for Medicaid Bilirubin Follow-Ups
Pediatricians are often assigned Medicaid patients born in the hospital who do not have th... Read more
Pediatricians are often assigned Medicaid patients born in the hospital who do not have th... Read more
Consultation vs. ED Codes:
Coding for ED Visits when the Patient Isnt Admitted
Sometimes a pediatrician must go to the emergency room to see a childusually, this happens... Read more
Coding for ED Visits when the Patient Isnt Admitted
Sometimes a pediatrician must go to the emergency room to see a childusually, this happens... Read more
Focus on Symptoms When Choosing the Diagnosis Codes for Menstrual Concerns
Frequently an adolescent will ask her pediatrician for advice about menstruation. Accordin... Read more
Frequently an adolescent will ask her pediatrician for advice about menstruation. Accordin... Read more
Use Both Td and DT Codes for Pediatrics
In the story on new CPT codes for 1999 in the November issue of PCA (81-82), we omitted ... Read more
In the story on new CPT codes for 1999 in the November issue of PCA (81-82), we omitted ... Read more
Three Strategies for Billing Lactation Counseling
When a new mother is having problems breast-feeding, its definitely a pediatric concern. T... Read more
When a new mother is having problems breast-feeding, its definitely a pediatric concern. T... Read more
New 1999 Immunization and Neonatal Intensive Care Codes Most Valuable to Pediatrics
The 1999 CPT codes, which will become effective in January, include new codes in two impor... Read more
The 1999 CPT codes, which will become effective in January, include new codes in two impor... Read more
Coding for Weight Loss:
Use Anorexia Nervosa Diagnosis Code with Caution
There is sometimes confusion about how to code weight loss. Were not doing a clinical stor... Read more
Use Anorexia Nervosa Diagnosis Code with Caution
There is sometimes confusion about how to code weight loss. Were not doing a clinical stor... Read more
Dont Mix Conscious Sedation and Consultation Codes
Although adult patients dont have to be sedated for x-rays, pediatric patients sometimes... Read more
Although adult patients dont have to be sedated for x-rays, pediatric patients sometimes... Read more
Diagnosis Coding Strategies for Immunizations Given Incidental to Sick Visits
Children may not mind getting fewer shots than they need, but parents and pediatricians tr... Read more
Children may not mind getting fewer shots than they need, but parents and pediatricians tr... Read more
Get Paid for Care When the Patient Isnt Present
The parents want to meet with the pediatrician to discuss their childs test results. The... Read more
The parents want to meet with the pediatrician to discuss their childs test results. The... Read more
E/M Revisions Delayed Until 1999 or Later
The new E/M guidelines won't be out for at least a year. They were supposed to be publishe... Read more
The new E/M guidelines won't be out for at least a year. They were supposed to be publishe... Read more
New Diagnosis Codes for 1999
The Health Care Financing Administration and the National Center for Health Statistics hav... Read more
The Health Care Financing Administration and the National Center for Health Statistics hav... Read more
Boost Practice Revenue with Comprehensive ICD-9 Coding
Sometimes diagnosis codes seem to get short shrift. Pediatricians, like most physicians,... Read more
Sometimes diagnosis codes seem to get short shrift. Pediatricians, like most physicians,... Read more
Three Quick Tips to Increase Payment for Rocephin Injections
Pediatric practices that bill for antibiotic injections have often found that Rocephin is ... Read more
Pediatric practices that bill for antibiotic injections have often found that Rocephin is ... Read more
Can Pediatricians Get Paid for Waiting for Delivery?
The problem of how to bill for your services when waiting for a laboring mother to deliver... Read more
The problem of how to bill for your services when waiting for a laboring mother to deliver... Read more
Newborns Without Insurance:
Reimbursement Tips
When a pediatrician sees a newborn in the hospital, he or she may well not know whether th... Read more
Reimbursement Tips
When a pediatrician sees a newborn in the hospital, he or she may well not know whether th... Read more
Billing Tips for Nurse Practitioner Services
Nurse practitioners (NPs) are very useful to pediatric practices. They can relieve the ped... Read more
Nurse practitioners (NPs) are very useful to pediatric practices. They can relieve the ped... Read more
Use Sick-Visit Codes to Bill and Get Paid for Preoperative Physicals
Preoperative physicals are problematic for pediatricians. This is because children have re... Read more
Preoperative physicals are problematic for pediatricians. This is because children have re... Read more
Careful Documentation of Face-to-Face Time is Key to Getting Paid for Prolonged Services
When a pediatrician spends an extended amount of time with a patient, he or she may bill f... Read more
When a pediatrician spends an extended amount of time with a patient, he or she may bill f... Read more
Get Reimbursed for an Office Visit and Cerumen Removal Even When the -25 Modifier Fails
When a pediatrician sees a patient and determines that its necessary to remove impacted ea... Read more
When a pediatrician sees a patient and determines that its necessary to remove impacted ea... Read more
Optimal Diagnosis Coding for a Suspected Ear Infection
The problem frequently arises in pediatrics: a baby is fussing and the mother is concerned... Read more
The problem frequently arises in pediatrics: a baby is fussing and the mother is concerned... Read more
Charging Co-pays for Nurse Visits:
Dos and Donts
When a child sees a nursefor just an injection or a weight check, for examplethe fee for t... Read more
Dos and Donts
When a child sees a nursefor just an injection or a weight check, for examplethe fee for t... Read more
Attention to Managed Care Fee Schedule can Prevent Decline in Reimbursements
In this era of mysteriously disappearing reimbursements from HMOs and PPOs, many pediatric... Read more
In this era of mysteriously disappearing reimbursements from HMOs and PPOs, many pediatric... Read more
Procedure Code Pitfall:
CPT Code 99230 Is Not Used for Fluorescein Strip
Sometimes an incorrect code is accepted for a procedure it was never designed to cover. Th... Read more
CPT Code 99230 Is Not Used for Fluorescein Strip
Sometimes an incorrect code is accepted for a procedure it was never designed to cover. Th... Read more
Correctly Code Newborn Admission:
99431 Should be Used Only On First Exam
Most pediatricians go to the hospital once or, maybe, twice a day for rounds. If the provi... Read more
99431 Should be Used Only On First Exam
Most pediatricians go to the hospital once or, maybe, twice a day for rounds. If the provi... Read more
Continuation:
Getting Paid for Suture Removal
In the July 1998 issue, we covered strategies for getting paid for laceration repair when ... Read more
Getting Paid for Suture Removal
In the July 1998 issue, we covered strategies for getting paid for laceration repair when ... Read more
CPT Update:
1999 Codes for Immunizations, Neonatal Intensive Care are on the Horizon
Its too early to get the actual code numbers, but its not too soon to rejoice in the new... Read more
1999 Codes for Immunizations, Neonatal Intensive Care are on the Horizon
Its too early to get the actual code numbers, but its not too soon to rejoice in the new... Read more
Billing and Coding Solutions for Pediatric Professional-Courtesy Visits
The professional-courtesy visit, in which children of other physicians are treated for fre... Read more
The professional-courtesy visit, in which children of other physicians are treated for fre... Read more
Optimal Coding When a Spinal Tap is Attempted but Not Completed
Experienced pediatric staffers know how difficult it can be to get a spinal tap done on a ... Read more
Experienced pediatric staffers know how difficult it can be to get a spinal tap done on a ... Read more
Correctly Code X-Rays Performed in the Pediatric Practice
If you do x-rays in your officeand many pediatricians doyou may have some questions about ... Read more
If you do x-rays in your officeand many pediatricians doyou may have some questions about ... Read more
Getting Paid for Using Hand-Held Mini Peak Flow Meters
When a pediatrician needs to ascertain how well a childs lungs are functioning, a peak f... Read more
When a pediatrician needs to ascertain how well a childs lungs are functioning, a peak f... Read more
Expert Reimbursement Tips for Pre-Op Physicals
Often a pediatrician will be asked to do a pre-op physical. And, as everybody knows, healt... Read more
Often a pediatrician will be asked to do a pre-op physical. And, as everybody knows, healt... Read more
Collect Increased Reimbursement for Seeing Walk-In and Emergency Patients
The not-so-secret problem with emergency care is that if patients go to the emergency room... Read more
The not-so-secret problem with emergency care is that if patients go to the emergency room... Read more
Tips on Office-Visit Codes for Discharged Healthy Newborns
Pediatric coders often have questions about first office visits for newbornswhen the pedia... Read more
Pediatric coders often have questions about first office visits for newbornswhen the pedia... Read more
Why CPT Doesnt View Time as a Key Factor
The Evaluation and Management (E/M) services codes covering the sick visits that are the... Read more
The Evaluation and Management (E/M) services codes covering the sick visits that are the... Read more
Get Paid for Laceration Repairs:
Beware of Coding Creep Among Payers
Almost two years ago, Blue Cross stopped paying Southern Orange County Pediatric Associate... Read more
Beware of Coding Creep Among Payers
Almost two years ago, Blue Cross stopped paying Southern Orange County Pediatric Associate... Read more
Coding for Newborns:
Critical, Neonate Intensive Care, or Normal?
In the March issue of Pediatric Coding Alert, Richard H. Tuck, MD, FAAP, an AAP coding tra... Read more
Critical, Neonate Intensive Care, or Normal?
In the March issue of Pediatric Coding Alert, Richard H. Tuck, MD, FAAP, an AAP coding tra... Read more
Incorporating the Sports Physical into Well-Visit Exam can Solve Coding Conundrum
This is the time of year when many pediatricians are busy doing annual physicalsand sports... Read more
This is the time of year when many pediatricians are busy doing annual physicalsand sports... Read more
How and When to Code for State-Supplied Vaccines
Expansion of the federal Vaccines for Children program to include private pediatric practi... Read more
Expansion of the federal Vaccines for Children program to include private pediatric practi... Read more
What to Do When Insurance Companies Bundle Individual Immunization Codes
Combination vaccines are growing by leaps and bounds, and this has some pediatricians wo... Read more
Combination vaccines are growing by leaps and bounds, and this has some pediatricians wo... Read more
Clarification
In the May issue of Pediatric Coding Alert, we discussed the use of prolonged services cod... Read more
In the May issue of Pediatric Coding Alert, we discussed the use of prolonged services cod... Read more
E/M Documentation Guidelines Postponed:
Where do Pediatricians Stand After AMA/HCFA Meeting on E/M
You can still use them if you want to...but why would you? The Evaluation and Management... Read more
Where do Pediatricians Stand After AMA/HCFA Meeting on E/M
You can still use them if you want to...but why would you? The Evaluation and Management... Read more
Cut the Coding Confusion When Newborn is Not Critical But Not Normal Either
When in doubt, use the lowest code possible -- that seems to be the philosophy of some ins... Read more
When in doubt, use the lowest code possible -- that seems to be the philosophy of some ins... Read more
Downcoding Alternatives to Help Your Self-Pay Patients
Pediatricians tend to be a soft-hearted group -- after all, they have chosen to spend th... Read more
Pediatricians tend to be a soft-hearted group -- after all, they have chosen to spend th... Read more
Accurate Diagnosis Coding for Immunization-Only Office Visits
There are times when an immunization is the only procedure a child needs. The best way to ... Read more
There are times when an immunization is the only procedure a child needs. The best way to ... Read more
-25 Modifier Utilization to Capture Office Visit Reimbursement with Catheterization
The -25 modifier has a bad reputation for not being reimbursed by some insurance compani... Read more
The -25 modifier has a bad reputation for not being reimbursed by some insurance compani... Read more
Getting Reimbursed Adequately for Two Hospital Visits in One Day
Sometimes a pediatrician must visit a hospitalized child more than once a day. But CPT spe... Read more
Sometimes a pediatrician must visit a hospitalized child more than once a day. But CPT spe... Read more
Overcome "Unspecific Condition" Diagnosis Codes Pay-up Challenges
One of the most challenging problems pediatric coders encounter is lack of a specific diag... Read more
One of the most challenging problems pediatric coders encounter is lack of a specific diag... Read more
Optimal Coding for ADHD Patients
Attention Deficit Hyperactivity Disorder (ADHD) can take a lot of time, both up-front and ... Read more
Attention Deficit Hyperactivity Disorder (ADHD) can take a lot of time, both up-front and ... Read more
Emergency Room Reimbursement for Pediatrics
Sometimes pediatricians are summoned to the emergency room because they know their patient... Read more
Sometimes pediatricians are summoned to the emergency room because they know their patient... Read more
Coding When Theres No Well-Child Coverage
It happens every day in most pediatricians offices: a new mother is standing at the front ... Read more
It happens every day in most pediatricians offices: a new mother is standing at the front ... Read more
Getting Paid for Mixing and Administering Antigen Injections
Allergy shots can help patients and be a profitable sideline for pediatricians, but someti... Read more
Allergy shots can help patients and be a profitable sideline for pediatricians, but someti... Read more
Collecting Co-Pays Before the Patient Is Seen:
It Can Be Done
When asked if they are collecting co-pays before the patient is seen, most pediatric offic... Read more
It Can Be Done
When asked if they are collecting co-pays before the patient is seen, most pediatric offic... Read more
Vision Screen Compensation:
Use Office-Visit Codes
Many pediatric practices conduct vision screens, but dont know how to code for extra reimb... Read more
Use Office-Visit Codes
Many pediatric practices conduct vision screens, but dont know how to code for extra reimb... Read more
Ambulance and Helicopter Transport Compensation Tips
Often a preemie needs to be transported from a rural hospital to one with a NICU. Or a new... Read more
Often a preemie needs to be transported from a rural hospital to one with a NICU. Or a new... Read more
Care Plan Oversight Codes:
Get Reimbursed in New 15-Minute Unit
Sheryl Cilento, office manager for Liberty Child and Adolescent Health Services, an 11-p... Read more
Get Reimbursed in New 15-Minute Unit
Sheryl Cilento, office manager for Liberty Child and Adolescent Health Services, an 11-p... Read more
Numbering of ICD-9 Codes on Claim Forms
Linda Kortanek, office manager for Northpoint Pediatrics, Indianapolis, IN, wants to know ... Read more
Linda Kortanek, office manager for Northpoint Pediatrics, Indianapolis, IN, wants to know ... Read more
Utilizing NICU and Critical Care Codes Correctly for Optimal Reimbursement
When a newborn is critically ill and is in the NICU there are specific CPT codes for the... Read more
When a newborn is critically ill and is in the NICU there are specific CPT codes for the... Read more
Use of the 25 Modifier when Combining Office and Well-Visits
Marc A. Tanenbaum, MD, of Atlanta, GA writes, We contract with over 40 managed care compan... Read more
Marc A. Tanenbaum, MD, of Atlanta, GA writes, We contract with over 40 managed care compan... Read more
Coding for Preventive Counseling
Dana Klar, practice manager for Mount Sinai Medical Associates in New York City, writes, W... Read more
Dana Klar, practice manager for Mount Sinai Medical Associates in New York City, writes, W... Read more
Another Two Carriers for 99436
In our continuing saga (which started in the March 1998 issue) of which payers are willing... Read more
In our continuing saga (which started in the March 1998 issue) of which payers are willing... Read more
New Conscious Sedation Codes Will Help Pediatricians
When an adult gets a laceration on his or her face, the area can be numbed and stitched ... Read more
When an adult gets a laceration on his or her face, the area can be numbed and stitched ... Read more
House Calls:
Reimbursement Opportunity in New Home Services Codes
Ever since colonial times, when babies were born at home and sick children remained there ... Read more
Reimbursement Opportunity in New Home Services Codes
Ever since colonial times, when babies were born at home and sick children remained there ... Read more
Office Visit Without a Pediatrician:
Using 99211 to Your Best Advantage
Sometimes your patients come to your office but dont see a pediatrician. They see a nurs... Read more
Using 99211 to Your Best Advantage
Sometimes your patients come to your office but dont see a pediatrician. They see a nurs... Read more
New E/M Services Guidelines:
Documentation of History in Pediatric Patients
The new Evaluation and Management (E/M) Services, which will be enforced by the federal He... Read more
Documentation of History in Pediatric Patients
The new Evaluation and Management (E/M) Services, which will be enforced by the federal He... Read more
Cut Through the New Observation Care Coding Confusion
With managed care having an increasing say over how long patients can stay in the hospital... Read more
With managed care having an increasing say over how long patients can stay in the hospital... Read more
Who is Reimbursing for 99436:
Insurance Company Poll
Theres a wonderful new code for attendance at delivery: 99436 (see PCA January 1998). It... Read more
Insurance Company Poll
Theres a wonderful new code for attendance at delivery: 99436 (see PCA January 1998). It... Read more
Some Tricky Questions and Answers About Treating Newborns
High-risk deliveries can mean a lot of waiting around for pediatricians. The physician is ... Read more
High-risk deliveries can mean a lot of waiting around for pediatricians. The physician is ... Read more
New E/M Services Guidelines:
Complexity of Pediatric Medical Decision-Making
There are three main areas in the Evaluation and Management (E/M) Services: examination, h... Read more
Complexity of Pediatric Medical Decision-Making
There are three main areas in the Evaluation and Management (E/M) Services: examination, h... Read more
Optimal Coding for Newborn Care
In the January 1998 issue of PCA we described the new attendance at delivery code -- 99436... Read more
In the January 1998 issue of PCA we described the new attendance at delivery code -- 99436... Read more
Correct Coding for New Vaccines
One of the new vaccine codes for 1998 is 90748, for the combined immunization of hepatitis... Read more
One of the new vaccine codes for 1998 is 90748, for the combined immunization of hepatitis... Read more
Tactics to Reduce Retrospective Coding Errors
Theoretically, all coding is supposed to be done by the person treating the child. The d... Read more
Theoretically, all coding is supposed to be done by the person treating the child. The d... Read more
Clarification:
Office Visits and Preventive Medicine Coding Continued
In the January 1998 issue, we covered the question of whether you can code a physical as... Read more
Office Visits and Preventive Medicine Coding Continued
In the January 1998 issue, we covered the question of whether you can code a physical as... Read more
Compensation Tips for Phoning in Prescriptions
In the old days, pediatric practices could afford to absorb the costs of calling pharmacie... Read more
In the old days, pediatric practices could afford to absorb the costs of calling pharmacie... Read more
Getting Reimbursed for Overtime with Surcharge Codes
There are three potentially lucrative codes to be used in addition to office-visit code... Read more
There are three potentially lucrative codes to be used in addition to office-visit code... Read more
Immunization Coding Crisis Solutions
Immunizations, an essential and frequent aspect of pediatric care, are creating a coding... Read more
Immunizations, an essential and frequent aspect of pediatric care, are creating a coding... Read more
Evaluation and Management Services:
New Documentation Guidelines, How They Apply to Pediatrics
The revised documentation guidelines for Evaluation and Management (E/M) Services have a... Read more
New Documentation Guidelines, How They Apply to Pediatrics
The revised documentation guidelines for Evaluation and Management (E/M) Services have a... Read more
Coding for Parent Education on Safety Issues
Its called anticipatory guidance, and its an essential part of preventive care for childre... Read more
Its called anticipatory guidance, and its an essential part of preventive care for childre... Read more
Office Visit vs. Preventive Medicine Coding
Preventive medicine services, the well visits that go from infant physicals through 65 yea... Read more
Preventive medicine services, the well visits that go from infant physicals through 65 yea... Read more
Making Modifier 25 Work for You
Often a child comes in for an office visit, and something else in addition to the original... Read more
Often a child comes in for an office visit, and something else in addition to the original... Read more
Its Not Standby Any More:
New Code for Delivery Attendance
Pediatricians who are requested to be at a delivery now have a code they can use for that ... Read more
New Code for Delivery Attendance
Pediatricians who are requested to be at a delivery now have a code they can use for that ... Read more
When Numbing and Circumcision are Bundled
Question: Renee Boston, office manager of Southwest Childrens Center, a five-pediatrician... Read more
Question: Renee Boston, office manager of Southwest Childrens Center, a five-pediatrician... Read more
Available Years:
1998