Pediatric Coding Alert

3 must-have edits prepare you for strapping, nebulizer, ECG denials & moreFind out when and how to break payment bundles for I&D, continuous inhalation treatment, and home apnea monitoring with these insider secrets.1. Include Applying Dressing in I&DIf your pediatrician performs an incision and drainage (I&D) and then applies an Unna boot, you may have to reduce your coding from two procedures to one. No bundling issues now exist on these procedures, says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop & Associates.But that's going to change for payers that follow Correct Coding Initiative (CCI) edits. Starting April 1, new version 14.1 puts an end to also coding the strapping (29580, Strapping; Unna boot). The CCI edits bundle Unna boot strapping code 29580 into five I&D codes and one debridement code including:• 10060 -- Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single• 10061 -- ... complicated or multiple• 10140 -- Incision and drainage of hematoma, seroma or fluid collection• 10160 -- Puncture aspiration of abscess, hematoma, bulla, or cyst• 11000 -- Debridement of extensive eczematous or infected skin; up to 10% of body surface.Exception: You may, however, report an Unna boot strapping with the above codes when the procedures occur on separate sites. "The edits permit you to use modifier 59 (Distinct procedural service) to break the bundle under extenuating circumstances, such as different anatomical sites, supported with documentation," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.Check Out Unna Boot Details"An Unna boot is a dressing and wrap combination that is applied from the foot to the knee," according to the Bishop, Calif.-based Northern Inyo Hospital's Unna Boot (Pediatric) Discharge Instructions.The boot's gauze contains a special medication to help heal burns or skin sores and protect new skin. Expect children with an Unna boot to visit the doctor to have the Unna boot changed every-one-to-three-days for a white bandage boot and weekly for the pink bandage. Code these services with 29580, which has zero global days.2. Choose Treatment Code Based on TimeBeware of one new bundle when coding inhalation treatments. You should not report an individual inhalation treatment, such as with a nebulizer, in addition to continuous inhalation treatment. CCI makes inhalation treatment code 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) a component of the more extensive procedure 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour).Warning: The edits do not allow [...]