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Pediatric Coding Alert

What Flu-Shot Component Is Costing You Dollars? Here's How to Find Out
4 simple steps help you submit flawless immunization claims If you report all influenza-va... Read more
You Can Eliminate Influenza-Vaccine Coding Mismatches
Clip and post your guide to reporting FluMist, Fluzone and Fluvirin With this season's flu... Read more
Watch Out:
CPT Contains 3 Fluzone Vaccine Codes
Check your influenza-inoculation billing skills with this quiz Apply your reading kno... Read more
Sports Exam Is Similar to Checkup in Face Value Only
 Tip: Look to service's extent, focus when coding 3 well-patient visits Even though ... Read more
Untangle Admissions From Office Visits:
4 Scenarios Show You the Way
Get the pay you deserve for 2-day services If you want to earn your fair share of reimburs... Read more
You Be the Expert:
Report Initial Hospital Care for Admits Only
Question: I was recently called into the hospital to take over the care of a patient whe... Read more
Here's How to Code Outpatient-to-Inpatient Encounters
Clip and save your combination E/M service chart If you're not sure what to report for hos... Read more
Reader Questions:
96110 Refers to Standardized Test
Question: A pediatrician uses a developmental form that our practice created to check youn... Read more
Reader Questions:
How to Bill for Overseeing Home Healthcare
Question: A child stepped on a rusty nail and developed Pseudomonas osteomyelitis. After t... Read more
Reader Questions:
Learn What Staff May Report 90465-90468
Question: When a nonphysician practitioner (NPP) who bills independently provides vaccine ... Read more
Reader Questions:
Check Payers' Meet-and-Greet Policies
Question: Most payers haven't been paying prenatal visit code G9001. Blue Cross Blue Shiel... Read more
Reader Question:
Same-Day Discharge? Report the 99234 Series
Question: We kept a patient in the hospital overnight for observation and decided the next... Read more
You Be the Coder:
How to Count Multiple Cyrosurgeries
Question: A 15-year-old girl presents for her annual exam and requests that the pediatrici... Read more
CPT 2005 Update:
Pediatricians Receive Vaccine-Administration Work Pay
Apply 90465-90468 when visit meets age, counseling criteria You will finally have a wa... Read more
Just When 90471-90474 Are Becoming Old Hat, CPT Throws You a Curve
Clip and post your guide to choosing the right vaccine-administration code setYou can succ... Read more
What's the Definition of a Neonate?
CPT makes neonatal codes consistent with ICD-9, WHO's time frameIf you've struggled with k... Read more
How to Bill Parent-Only Visits
Tip: Use time as the key element when reporting counseling encounters When you discus... Read more
Correction:
Report Controlled Diabetes With 250.01, Not 250.03
If you mix up your "1" and "3" subclassifications, you're not alone.In the October 2004 Pe... Read more
Reader Question:
Here's When to Apply Fracture Care or Cast Removal
Question: A pediatrician sees a patient to determine if her fracture has healed. His evalu... Read more
Reader Question:
How to Ethically Override Same-Day E/M Bundle
Question: If two pediatricians in the same group see the same office patient on the same d... Read more
Reader Question:
TCI Posts CMS' TB Explanation
Question: Before we bill 99211 when a nurse interprets a tuberculosis (TB) test result, we... Read more
Reader Question:
Look for Incision to Determine Splinter-Removal Code
Question: Which CPT code(s) should I use for a splinter removal? Answer: You should usuall... Read more
You Be the Coder:
Discover Which ICD-9 Code(s) Pediarix Requires
Question: When a nurse administers the Pediarix vaccine, should I use diagnoses codes V0... Read more
ICD-9 2005's Top Pediatric Change:
Child's Insulin Use No Longer Indicates Which Diabetes Code Applies
Look to pancreatic beta cell condition to determine type I, II dx Do you think you score 1... Read more
Becoming an Expert Diabetes Coder:
We'll Show You How to Develop Your Staff's 250.xx Skills
You can avoid miscoding diabetes claims if you take two steps and a coding quiz.  ... Read more
Coding Tool:
Using ICD-9's New Entries: 3 Instances When V01.xx Will Come in Handy
Add abnormal PKU code, metabolic codes to your encounter sheet You can avoid rejections fo... Read more
Watch Out:
You Shouldn't Code All ED-Related Care the Same Way
2 case studies show you when to bill a telephone call, consultation and admission If you'r... Read more
Reader Questions:
Clinic Coders, Beware: 99054 May Be for You
Question: The July 2004 Pediatric Coding Alert reader question "Open on Sundays? Charge 99... Read more
Reader Questions:
Postdischarge Jaundice Dx Hinges on Hospital Care
Question: My co-workers think it's appropriate to use jaundice as the diagnosis in the fol... Read more
Reader Questions:
Pulling on Ears Indicates Otalgia
Question: In the July 2004 Pediatric Coding Alert reader question "Include Tube Check in O... Read more
You Be the Coder:
How to Distinguish a Hearing Screen From a Retest
Question: A pediatrician re-examines a child who failed an initial hearing screen and find... Read more
Are You Reporting Developmental Testing? 3 Scenarios Show You the Wa
Hint: Use modifier -25 to unlock E/M-96110 reimbursement Stop bundling developmental test... Read more
Closure Level Matters When Coding Tissue Adhesive Repair
2 questions can get you as much  as $120 If you're reporting tissue adhesive repair... Read more
Use This Easy Way to Check Your Patient's 96110 Eligibility
Clip and post your guide to separately identifiable developmental screenings If you aren'... Read more
Proper Diagnosis Codes Bring Clear Hearing-Screening Pay
 Tip: 388.40 can often do the trick Looking for the key to collecting fair hearing-t... Read more
Carry Out ICD-9 Codes to the Most Specific Digit Possible
The most complete diagnosis code is not always 5 digits If you are submitting CPT code... Read more
You Be the Expert:
Has ICD-9 Coding Lost Its Grace?
Question: Is it true that CMS has done away with the 90-day grace period for getting used ... Read more
ICD-9 Coding Success Hinges on Communication
Doc should always approve ICD9 Codes, experts say There's a right way and a wrong ... Read more
Reader Questions:
Pay Attention to ADHD Requirements
Question: We had a patient present for a visit regarding ADHD and the effectiveness of her... Read more
Reader Questions:
Coding Blood Collection
Question: Which code should we use for a blood  draw only? We do not have a lab, and ... Read more
Reader Questions:
Get Specific With E Codes
Question: When should we use E codes? Do they help us collect reimbursement?Arizona Subscr... Read more
Reader Questions:
Don't Let Bee Stings Complicate Your E/M Coding
Question: A patient presented to our office with complications from a bee sting. Our pedia... Read more
Reader Questions:
Don't Accept Consultation Frequency Limits
Question: Does a time limit exist on how long must pass before I can bill 99241-99245 on t... Read more
Reader Questions:
Assign Type I for Patients With Type 1.5 Diabetes
Question: Type 1.5 diabetes, or latent autoimmune diabetes of adulthood (LADA), still does... Read more
Reader Question:
Use Web to Get ICD-9 Help
Question: In our office, we strive to have the most accurate ICD9 Codes each time we send... Read more
You Be the Coder:
CPS Request? Code a Consultation
Question: Some of my pediatricians see child protective services (CPS) clients for preplac... Read more
NCCI 10.2 Bundles Lidocaine Into Hundreds of Procedures
If you were billing J2001 with your injections, the latest edits will get your attention ... Read more
Top-3 Q&A's for Billing Rocephin With Lidocaine
Don't let J2000 deletion stand in the way of proper reimbursement Have your lidoca... Read more
99211 & PPDs:
Don't Lose Out on Ethical Reimbursement
Not billing CPT 99211 for PPD readings? You could be losing $21 per visit If you'... Read more
Don't Shy Away From Time When Reporting Child Abuse Exams
Coding for possible and obvious trauma cases can be easy if you know what to look for The... Read more
Can't Confirm Abuse? Specific Exam Codes Are the Answer
Signs and symptoms or V code may be your key in these situations If you can't confirm chi... Read more
You Be the Expert:
Rape Codes
Question: What codes should I report for a rape exam for a 10-year-old female patient? ... Read more
Reader Question:
No-Show? No Code
Question: We regularly have patients who don't show up for their appointments and don't t... Read more
Reader Question:
Swallow the Cost of Tylenol
  Question: Is there a HCPCS code for the supply of Tylenol for a sick patient? ... Read more
Reader Question:
Don't Abuse Consultation Codes
Question: I can't seem to collect reimbursement for CPT 99401 when I report it for a co... Read more
Reader Question:
John Hancock Alone Might Not Cut It for EKGs
Question: Our doctors think that since our electrocardiogram (EKG) machine generates a co... Read more
Reader Question:
Report E/M Code for Ear Wick
Question: Which code should we report for an ear wick? Oklahoma Subscriber Answer: Ear-wi... Read more
Reader Question:
X-Ray Interpretation Only? Add -26
Question: How should we report a scenario in which the physician did not take x-rays but ... Read more
Reader Question:
Stick Your Neck Out for Correct ROS Choice
Question: Our doctors use the phrase "neck is supple" all the time in their documentation... Read more
Reader Question:
Breathe Easy When Coding Asthma Visits
Question: One of our asthma patients presented with a little chest tightness and required... Read more
Reader Question:
Code for Both DDST-II and E/M
Question: A parent brought her 11-month-old in for testing for delayed language developme... Read more
Reader Question:
Look for Signs of Abuse
Question: What are some of the signs of physical, sexual and/or emotional abuse in a chil... Read more
You Be the Coder:
Base Follow-Up Diagnosis on Initial Visit
Question: In the July 2004 issue of Pediatric Coding Alert, you gave an example of a mot... Read more
The Surefire Way to Collect 'Unspecified Sinusitis' Pay
Get the inside scoop on combating payers' 461.9 rejections If your insurer denies your E... Read more
ICD-9 2005 Preview:
New V Code Makes Billing Chicken Pox Exposure a Snap
Our clip-and-post chart reveals upcoming pediatric diagnostic additions Does your prac... Read more
4 Examples Show You When to Charge NPP E/Ms at 100 Percent
Private payers may implement these Medicare incident-to requirements Want to capture an a... Read more
4 Steps Reduce Denials for Teaching Physician Services
Techniques can clarify confusing Medicare guidelines When a pediatrician works as a &q... Read more
You Be the Expert:
TP Rules and Med Students
Question: I've heard about the new teaching physician (TP) guidelines and was wondering w... Read more
Reader Question:
Significant Well-Check Problem Warrants 2 Codes
Question: When should I bill an office visit in addition to a preventive exam code? India... Read more
Reader Question:
Allergy Injection Codes Include Administration
Question: When we administer allergy injections with patient-supplied allergenic extract... Read more
Reader Question:
Include Tube Check in Office Visit
Question: Based on a mother's complaint that her son who has tubes is pulling on his ears... Read more
Reader Question:
Tally Time to Capture Toxic Lead Visit
Question: Achild presents with a high lead toxicity level. The pediatrician counsels the ... Read more
Reader Question:
Open on Sundays? Charge 99054
Question: We routinely see sick patients on Sunday mornings. May we use 99054 for these p... Read more
Reader Question:
Know the Meaning of 'Immediately Available'
Question: If the pediatrician has to leave the room for a few minutes during a procedure ... Read more
You Be the Coder:
How to Code Office Visit Chemocauterization
Question: A pediatrician evaluates a newborn and then performs umbilical cord granulatio... Read more
How to Get Suture Removal Pay Without Using A Procedure Code
  Latest on CPT Code for Suture Removal from Codify's Pedia... Read more
3 Secrets Capture $20 or More In Sick Visit-Vaccination Pay
Diagnosis is key to 99213 payment Are payers denying rechecks with rescheduled immuniz... Read more
Insurer Spotlight:
Are Your Payers Counting 99211s as Well Visits?
Here's how to appeal improper benefit allotments You'd better perform your own preventive... Read more
Reporting Related Codes? Use Modifiers -59 and -51 to Keep Claims Clear
Append -59 for procedures not normally coded together When a patient reports for a nebu... Read more
You Be The Expert:
Check CPT for Modifier -51 Exemptions
Question: Do I have to use modifier -51 every time I code a visit in which the pediatric... Read more
Reader Question:
Review HCPCS for Casting Supplies
Question: When a physical therapist (PT) or an occupational therapist (OT) who works in ou... Read more
Reader Question:
Factor Handheld Peak-Flow Test Into E/M
Question: What is the difference between vital capacity and peak flow? We report CPT 94150... Read more
Reader Question:
Testicular Dysfunction Code Specifies Gender
Question: Our pediatrician wants to use diagnosis code 257.8 for a 15-year-old female. Sh... Read more
Reader Question:
Use E/M for Suspected Sexual Abuse
Question: Another facility referred a mother who suspected that someone had abused her chi... Read more
Reader Question:
99211 + 95115: You Decide
Question: Should I report CPT 99211 in addition to 95115 if the nurse monitors an allergy... Read more
Reader Question:
Indwelling Differentiates 51701 From 51702-51703
Question: When a pediatrician uses a catheter to obtain a sterile urine sample from a pati... Read more
Reader Question:
Apply Different V Codes to Twins' Discharge
Question: When my pediatrician discharges normal twins from the hospital, should I use the... Read more
Reader Question:
Modifier -59 Indicates Separate Repairs
Question: A 4-year-old established patient reported to the office after falling down the ... Read more
You Be The Coder:
How Should We Report Fingerstick With E/M?
Question: A child presents with fever, congestion and headache. The pediatrician takes a... Read more
Case Study:
1 Clever Rule Nets You Almost $230 for Repeat Asthmatic
Learn how to combine encounters to optimize your group practice pay You can ethically... Read more
Are You Coding Fractures Correctly? Bone Up With a Review of 2 Options
Report separate E/M services with modifier -25 when using global fracture-care code When ... Read more
You Be The Expert:
How to Code Off-Site X-Ray Interpretations
Question: A 6-year-old patient reported with left wrist pain from playing croquet. The ped... Read more
Reader Question:
Can You Find a Code for Trauma-Team Activation?
Question: We have a busy inpatient trauma service. Some authorities recommend using a trau... Read more
Reader Question:
How to Bill RT-Assessment Services
Question: Does a therapist qualify as a physician extender? A respiratory therapist (RT) w... Read more
Reader Question:
You Should Use 36415 for Multiple Draws
Question: When we bill 36415 x 7 with V77.1 for a diabetes screening that an outside lab ... Read more
Reader Question:
Don't Add 99354 to This E/M Service
Question: A patient presents for a scheduled well visit (99391). The patient's medical pro... Read more
Reader Question:
Count Your Rehydration Time in Office Visit
Question: What is the best way to code the time the pediatrician or nurse spends for oral ... Read more
Reader Question:
Use Modifier -24 for Unrelated E/M Service
Question: A 9-year-old patient reported three weeks ago for pain in her right shoulder aft... Read more
Reader Question:
Know Payer Policies for Fracture Coding Success
If you know what the carrier wants, you'll get what you want A lot of the confusion about ... Read more
You Be The Coder:
Coding a Sick/Well-Check Visit
Question: A parent schedules an appointment for a child's 12-month checkup. Our pediatrici... Read more
4 Tips Improve Your 51701 Encounter Pay
Combat E/M and catheterization denials with documentation, diagnoses and modifierWhen bill... Read more
Case Study:
How to Recoup an Extra $200 In Precatheterization Services
Look for these 3 E/M-related billing possibilities You can improve your catheterization e... Read more
Destroy This Myth:
You May Use V20.2 as a 'Catchall' Vaccine Diagnosis
4 reasons to assign a specific ICD-9 code for each immunization Should you save yourself ... Read more
How to Score 100 on Immunization Diagnostic Coding
Clip and save your guide to billing 20 pediatric vaccines... Read more
Punch Up Your E/M Claims With Prolonged Service Codes
Account for extra service time with add-on codesIf your pediatrics practice isn't using pr... Read more
You Be The Expert:
Prolonged Service or Level-5 Visit?
Question: An established 9-year-old patient undergoing treatment for a urinary tract infec... Read more
Code for Non-'Face-to-Face' Prolonged Service, Too
Experts report uneven reimbursement for the code setProlonged service codes are most often... Read more
Reader Question:
Clever Way You Can Report No Current Problem
Question: A nurse performs a weight and color check on a newborn whom the pediatrician wan... Read more
Reader Question:
Don't Use Units With Allergy Injections
Question: For multiple allergy injections in which the patient brings in the serum, I repo... Read more
Reader Question:
2 Methods Improve Your Protime Coding
Question: How should I code for monitoring Protime when the patient has gone to the labora... Read more
Reader Question:
Check Payer Policy for OV With PE Billing
Question: A 14-year-old presented for an annual physical. During the preventive exam, the ... Read more
Reader Question:
Append Modifier -21 Only to Level-5 E/M Codes
Question: Since there are no prolonged service codes for under 30 minutes of extra E/M tim... Read more
You Be The Coder:
Ring Removal
Question: A boy comes into our office with a ring stuck on his finger. The doctor administ... Read more
3 Tips Improve Your Antibiotic Injection Pay
Reviewed on April 29, 2015 You can ethically increase your reimbursement for Rocephin... Read more
Get Paid for Nonphysician Counseling:
Here's How
... Read more
E/M or Health and Behavior Modification Code? You Decide
If you think your office might provide assessment and intervention, but you're not sure wh... Read more
Modifier Is Key to Optimal Lumbar Puncture Coding
Tell insurer whether to adjust payment for unsuccessful spinal tapsIf you perform an unsuc... Read more
Use 'Nurse Visits' to Max Out Office Productivity
Offices forfeit pay if nurses don't perform most level-one established patient E/M service... Read more
You Be The Expert - Reporting Removal of Stitches
Question: A 10-year-old patient reported to the office to have sutures removed from a supe... Read more
Co-Pay or No Co-Pay? That Is the Question
Collect required co-pays - even if it feels wrongWhen an established patient reports ... Read more
Reader Question:
Write Off Pulse Ox Denials
Question: What can I do about payers bundling pulse oximetry with office visits? I often p... Read more
Reader Question:
Use IM Code for Lupron
Question: If a patient brings in Lupron, how should I code the injection?New Jersey Subscr... Read more
Reader Question:
E Codes Identify Accidents
Question: In the February 2004 Pediatric Coding Alert Extra, the "You Be the Expert" scena... Read more
Reader Question:
Fee Schedules Reveal Modifier -24 Requirements
Question: How can I find out how many postoperative days a surgery, such as CPT 51701 (In... Read more
Reader Question:
Document 'Nurse Visits' to Justify E/M Code
Question: A 6-year-old patient with a history of strep throat reported to the office with ... Read more
You Be The Coder - ADD/ADHD Evaluation and Testing
Question: When new and established patients come into a pediatrician's office for an atten... Read more
Abuse Exams:
4 Scenarios Show You What to Code When
A guide to reporting possible and obvious trauma cases E/M and ICD9 Codes for child-a... Read more
Dispel 3 Telephone Care Coding Myths
If you're not reporting phone calls because of coding and compliance concerns or rei... Read more
Is That a 99371, 2 or 3?
Don't sacrifice dollars delivering telephone care If you're unsure what counts as a simple... Read more
5 Questions Ease Your Nebulizer Coding Concerns
If denials for nebulizer training with treatment stump you, get a grasp on what you should... Read more
Losing Money on Modifier -25 Claims? Here's How to Improve Your Pay
Everyone uses modifier -25, but who uses it properly? Before you attach modifier -25 to a... Read more
You Be the Expert:
Filing an E/M Service and Fracture Repair
Question: An established patient reported to the office after falling off the monkey bars ... Read more
6 Suggestions for Foolproof Modifier -25 Coding
Who knew that one little modifier could cause so many headaches? Put modifier -25 on your ... Read more
Correction:
Publishers Add Instructions to ICD-9 Manual
Be careful that you don't assume all ICD-9-CM directives come from ICD-9.   I... Read more
Reader Question:
Patient Switches to a Covering Pediatrician
Question: When my pediatrician covers for another local private-practice pediatrician, I c... Read more
Reader Question:
Weight Drives Hospital, Intensive Care Coding
Question: For daily hospital rounds when a baby is no longer critical, should I move to ho... Read more
Reader Question:
Properly Reporting OM Is the Right Thing to Do
Question: Regarding November 2003's Pediatric Coding Alert article "Case Study: 4 Answers ... Read more
Reader Question:
Report Preventive, E/M Services Separately With Modifier -25
Question: An established patient of high-school age came in for a sports physical early on... Read more
You Be the Coder:
Treat Partnering Pediatricians' Visits as One
Question: A mother brings her 9-year-old son in for a croupy cough in the morning. Later t... Read more
4 Rules Repair Your Laceration Coding
Experts reveal when to report intermediate repair codes If you resort to simple repair... Read more
Test Your Laceration Coding Know-How
Determine how you would code these laceration repairs If you're still unsure abou... Read more
Don't Shy Away From Coding Same-Day Dialysis, Admission
3 steps boost your nephrology dollars' Pediatricians who perform dialysis services... Read more
6 Suggestions for Foolproof Modifier -25 Coding
Who knew that one little modifier could cause so many headaches? Put modifier -25 on your ... Read more
Restructure Appeals With These 6 Steps
Get organized for easier, more productive appeals When your practice receives a denia... Read more
Read EOBs Before Responding to Denials
What 'noncovered service' really means to your office You can't streamline... Read more
You Be the Expert:
What Makes a Clean Claim?
Question: We are having problems in our family  practice with the number of claims ... Read more
Reader Question:
You Can Code for Giving Synagis Without Supply
Question: What CPT Code should I use for a Synagis injection when the patient's par... Read more
Reader Question:
Differentiate NEC from NOS
Question: What do "NEC" and "NOS" mean in ICD9 coding? How should I ... Read more
Reader Question:
Stick With E/M Codes for Sports Physicals
Question: Our practice has so much trouble getting reimbursed for sports physicals. I just... Read more
Reader Question:
E/M Includes Peak Flow
Question: I never know when to charge for peak flow separately or when the visit includes ... Read more
Reader Question:
Bill for Multiple Foreign-Body Removal
Question: A pediatrician removes a bead from each of a child's ears without anesthesia. Sh... Read more
Reader Question:
What Counts as ROS Versus PFSH
Question: A grandmother brings her granddaughter in for a swollen and sore wrist. The woma... Read more
Reader Question:
Bridge the Communication Gap ASAP
Question: The physicians and billers in my office don't practice open communication, and i... Read more
You Be the Coder:
Coding Pain-Reduction Services
Question: A 9-year-old diabetes patient refuses injections because of pain. Our diabetes n... Read more
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