Code Diabetes Cases for Maximum Ethical Reimbursement
Published on Wed Nov 01, 2000
When pediatric patients have diabetes, they have special needs that make the entire coding picture very important. If pediatricians do not use all of the codes that are appropriate, and do not have a plan for proper billing, they run the risk of losing adequate reimbursement. These cases can take up an inordinate amount of time and are very involved in terms of decision-making. How can you manage these patients in your own practice without losing money? The comprehensive coding approach is the best answer. This includes:
1. Telephone codes. Theres a lot of telephone management, especially when the diagnosis is first made, says Joel Bradley, MD, FAAP, editor of the current edition of Coding for Pediatrics published by the American Academy of Pediatrics. Usually, these calls are daily for the first few weeks, he says. This is a situation in which you can legitimately bill the telephone codes, he says. Youll have quite a lot of telephone time, with parents and other providers. The telephone codes are listed under case management services, and there are three tiers for different levels of involvement: simple (99371), intermediate (99372) and complex (99373).
Insurance companies generally wont reimburse the telephone codes. But in the case of pediatric diabetes, says Bradley, they very well may love them. Why? Because your time spent on the phone with the parent will help keep the child out of the hospital. Write a letter to the insurance company telling them youll be billing for the phone codes, recommends Bradley.
2. Education. Some children take medication orally, but most must get injections. Blood sugar must be tested as often as six times a day, necessitating a finger prick each time. This is all done at home by the parent or, in the case of an older child or an adolescent, the patient may do it. The medication be given and the blood sugar tested, but the parent and child need to be trained in these procedures.
If the pediatrician does the teaching, then you could code an evaluation and management (E/M) services code (99212-99215). If the nurse does the teaching, the highest code you could use would be CPT 99211 . Considering that it may well take an hour for the initial teaching, you may want to take advantage of a diabetes management program that the familys insurance plan offers. In this program, a nurse visits the home and provides teaching on injection techniques, blood sugar testing and other issues as well, including diet. My only objection to using the patients insurance plan for education is that there is no communication with the physician, says Bradley.
There is another option, though: code 97535 (self care/home management [...]
