Pediatric Coding Alert

By A.D. Jacobson, MD, FAAP

Chairman of the American Academy of Pediatrics (AAP) section on administration and practice management, A.D. Jacobson, MD, FAAP, is a full-time pediatrician as well as a coding expert. He served on the AAPs coding and reimbursement committee and is past editor of the AAPs Coding for Pediatrics. He practices with Pediatric Associates, a four-pediatrician practice in Phoenix, Ariz. These tips are the second part two of a two-part series.

There are many everyday occurrences in a pediatric practice that are rich in coding challenges and solutions. Last month in this column I reviewed some ways to think creatively about coding. This month, I deal with some more common situations, and also some specific areas in which pediatricians could code but dont.

1. Nurse visits. This code (99211) is the lowest level of established patient coding and does not require face-to-face contact with a physician. This is usually done by a nurse. Here are some examples:

Immunizations: Code CPT 99211 can be used in addition to the administration code for the vaccines, as well as for the vaccine code itself. You may need to use a -25 modifier (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service).

Note: This is a controversial area. Some coding experts say you cannot use both 99211 and the administration code for the same visit.

Positive strep test: If a patient has a positive rapid strep test, the pediatrician needs to determine before writing a prescription whether there are any allergies to antibiotics. Also, the pediatrician needs to see whether strep is a recurrent problem for the child. This must be a face-to-face encounter although it can be with the nurse.

Ritalin refills: This is a good opportunity to use 99211. Again, this must be a face-to-face encounter with the nurse. You cannot use 99211 for having a prescription written and giving it to the patient when he or she walks in.


2. Emergency add-on code. If you see a patient on an emergency basis, you can add on code 99058 (office services provided on an emergency basis) for additional reimbursement. Typical emergencies include an acute asthma attack (493.01), a febrile neonate (780.6), and a laceration. In addition, many walk-ins are emergencies.

3. Hearing screening. If you use evoked otic acoustic emission hearing screens (Audiopath), you can bill 92587 (single level) or 92588 (multiple levels and frequencies) for added reimbursement, which varies from $50 to $100. You may need to use modifier -25 on the E/M service.

4. Orthopedic procedures. There are several orthopedic procedures that are commonly performed by pediatricians. You can [...]