Pediatric Coding Roundup
Published on Fri Jan 01, 1999
Editors Note: Coding advice and strategies offered in this section are verified by various members of PCAs Editorial Advisory Board.
Billing for Laceration Repairs
with Dermabond
For the procedure, you should use the laceration repair codes. You would probably only use the starred procedure codes (those that include the surgical procedure only), as Dermabond would be used on the smaller lacerations (12001, 12002, 12004, 12011, 12013, 12031, 12032, 12041, and 12051). There is a proposal at the AMA to include verbiage about Dermabond in the laceration repair codes, so there will be no question that they are appropriate when this product is used instead of sutures. But the real problem is getting paid for the substance itself. There is no CPT code for Dermabond repair. And there is no HCPCS code for the supply. So you need to use CPT 99070 and attach a copy of the invoice. 99070 is for supplies and materials provided by the physician over and above those usually included with the office visit or other services rendered. It is under special services and reports and often unpaid. As one practice told us, Were not using Dermabond. It costs too much, and we have no way of getting reimbursed. Some experts think it is unlikely that there will ever be a HCPCS supply code for Dermabond, since there isnt one for sutures (sutures are included in the laceration repair codes).
Tips on Camp Physicals
A 15-year-old comes in for a complete physical prior to entering an Outward Bound program for teens with behavioral problems. The last physical took place less than 12 months ago. Insurance coverage doesnt pay for more than one well visit a year. Yet the parent insists that insurance will pay if only the practice bills correctly. How do you respond?
Collect from the patient up frontimmediately after the child has been examined, advise our sources. If the parent resists, call the insurance company immediately, with the parent standing by. You can call the number on the back of the parents insurance carddont bother your provider relations person with this. When the parent hears from the insurance company that the visit isnt covered, he or she will understand who is responsible for the charge.
Note: If you want to make sure you collect for these camp physicals, you should get the payment before, not after, the exam.
New Vaccine Administration Codes
Now that there are finally codes for administering vaccines (90471 for a single or combination vaccine, 90472 for two or more single or combination vaccinessee article on the cover of the November issue of PCA), here are the rules on how they should be used, according to Bela Agrawal, senior health policy analyst at the American Academy of [...]
