Pediatric Coding Alert

See what the total revenue increase could be for all 7 services.

Over the last two months, we’ve looked at four ways to boost revenue for your practice, which could potentially help you adjust care programs, upgrade office equipment, adjust care, and improve patient outcomes. This month we explore the final three improvement opportunities as suggested in the webinar titled, “7 Pediatric Services That Will Save Your Patients… And Your Practice,” presented by Jan Blanchard, CPC, CPMA, pediatric solutions consultant at Vermont-based PCC.

Here we conclude this three-part series that examines each of those services to show you how and why your patients and practice could benefit with just a few adjustments.

Note: Most of these tips function under the following baseline assumptions:

A single clinician with a full-time workload equates to working four days a week, which means approximately 25 patients a day for approximately 50 weeks per year, which is roughly 5,000 visits per year.

Practices have quick access to their sick-visit-to-well-visit ratio (well care pays differently than sick care does).

Clearly, not all services discussed occur daily. Some services are seasonal, some are weekly, and so on. Additionally, because new patients are only new once during a three-year period, these calculations are made with only established patients in mind.

5. Speculate ‘Simple’ Treatments

Often patients show up in your practice with self-limited problems that don’t require much expertise to assess and treat, such as sunburns, umbilical cord cauterization, and nosebleeds. “Too often, a lot of these ‘little procedures’ aren’t billed by pediatricians. But the procedures aren’t, in fact, little,” says Chip Hart, director of PCC’s Pediatric Solutions Consulting Group at Vermont-based PCC and author of the blog “Confessions of a Pediatric Practice Consultant.”

Patient benefit: Parents are bringing you these conditions. They’re looking for treatment, but also for the reassurance and advice you give them. “Give yourself the credit you deserve for the comprehensive care that you offer,” said Blanchard.

Financial details: Some of these treatments might be more seasonal, such as sunburns, so there will be some variation here; but these numbers should give a rough idea of revenue potential.

Here’s how it breaks down:

• 36 sunburn visits, which is $58.26 ($2,097.36)
• 12 umbilical cord cauterizations, which is $64.25 ($771.00)
• 24 nosebleeds, which is $119.28 ($2,862.72)
• Combined total is $5,731.08 per clinician per year

Coding:

• 16000 (Initial treatment, first degree burn, when no more than local treatment is required)
• 17250 (Chemical cauterization of granulation tissue (ie, proud flesh))
• 30901 (Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method)

​Challenges: You’re doing these treatments, but you might not recognize them for what they are, so getting used to that might present challenges at first. For example, “first-degree burn care is sunburn care,” said Blanchard. Whatever you do to treat that sunburn is perfectly billable with 16000. It is in the surgical section of CPT^®, “but don’t let that fool you,” she said. “That’s just how the manual is organized.”

6. Foresee Foreign Body Removal

Whether it’s draining a simple abscess, a last-minute earwax irrigation, or retrieving a lost toy up an infant’s nose, a lot of practices don’t end up billing for these kinds of treatments, which might be a mistake.

Patient benefit: Patients need these services provided, but sometimes more important is the reassurance the parents need that these conditions are treatment and often not as serious as they seem. Don’t underestimate the value in that reassurance.

Financial details: With the payment averages listed below, it’s easy to see how quickly the numbers can add up.

Here’s how it breaks down:

• 12 simple abscesses with incision and drainages (I&D), which is $96.56 ($1,158.72)
• 12 simple subcutaneous procedures, which is $118.26 ($1,419.12)
• 6 intranasal, which is $169.87 ($1,019.22)
• 6 external eye, which is $52.98 ($317.88)
• 24 impacted cerumen with irrigation, which is $11.20 ($268.80)
• 24 impacted cerumen with instruments, which is $41.08 ($985.92)
• Combined total is $5,169.66 per clinician per year

Coding:

• 10060 (Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single)
• 10120 (Incision and removal of foreign body, subcutaneous tissues; simple)
• 30300 (Removal foreign body, intranasal; office type procedure)
• 65205 (Removal of foreign body, external eye; conjunctival superficial)
• 69200 (Removal foreign body from external auditory canal; without general anesthesia)
• 69209 (Removal impacted cerumen using irrigation/ lavage, unilateral)
• 69210 (Removal impacted cerumen requiring instrumen­tation, unilateral)

Challenges: There is no CPT^® for fluorescein, so if the pediatrician uses that to flush an eye to check for corneal abrasion, that’s still part of your standard E/M code.

Understand the Potential in Patient-Initiated Remote Care

When parents call about their child’s health over the phone, and the doctor or other qualified healthcare professional (QHP) takes standard evaluation and management steps, it’s likely a billable service.

Patient benefit: “This is quality care and patient satisfaction. This is keeping a new mom from having to bundle up a newborn and take them out into the world,” said Blanchard. Aside from patient convenience, this helps keeps established patients out of emergency rooms.

Financial details: The following is an example of how even just the use of a few of these codes each year could affect your practice.

Here’s how it breaks down:

• 120 5–10-minute calls with the doctor, which is $1.68 ($201.60)
• 400 5–10-minute calls with the QHP, which is $7.73 (3,092.00)
• 200 11–20-minute calls with the QHP, which is $24.62 ($4,924.00)
• Combined total is $8,217.60 per clinician per year

Coding:

• 99441 (Telephone evaluation and management service… not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion)
• 99442 (… 11-20 minutes…)
• 99443 (… 21-30 minutes…)
• 98966 (Telephone assessment and management service provided by a qualified nonphysician health care profes­sional… 5-10 minutes of medical discussion)
• 98967 (… 11-20 minutes…)
• 98968 (… 21-30 minutes…)

Challenges: Because reporting these requires that the patient not have a related E/M in the seven days leading up to the call, and the call cannot result in the patient coming in for the next available appointment, you can’t bill these immediately after the call. You need to wait to see if there will be a subsequent encounter.

Boosting your bottom line: Patient care and satisfaction is important, but a healthy practice also finds ways to increase revenue. Remember, it’s not about lining pockets. It’s about finding ways to simultaneously increase revenues while improving patient care.

To recap, these are the seven services discussed in this three-part series:

• Fluoride
• Hearing & Vision
• Development Screening
• After Hours Care
• “Simple” Treatments
• Foreign Body Removal
• Patient-Initiated Remote Care

Total revenue increase: If you haven’t billed for any of these services regularly but you started to right now, then each clinician could bring in an additional $55,276.64 annually if they performed an average number of each service.

For access to the full webinar, go to https://info.pcc.com/7-pediatric-services-that-will-save-your-patients-and-your-practice-lp.