Pediatric Coding Alert
Consider Options for New 'Flu Shot Only' Patients
Question: We are trying to decide how to handle new patients who want to come in just for a flu vaccine. The parent declines a well visit because it "isn't due yet" (insurance wouldn't cover an "extra" check-up), but we are not comfortable bringing in a totally new patient to just have a medical assistant do a vaccine. We want them to see a doctor for a brief visit to establish the patient, and then have the medical assistant do the vaccine. How can we collect for this?
Alabama Subscriber
Answer: Typically if it is a new patient, the insurance will pay for the "additional" preventive medicine visit, even if it occurs at less than a one year interval. If not, the practice will either provide a brief preventive medicine visit at no charge as a practice builder, or bill a reduced preventive medicine visit (52 modifier) which the family will be responsible for paying out of pocket. In this situation, having the family sign an advance beneficiary notice (ABN) is optimal to avoid any misunderstanding.
Pediatric Coding Alert
- E/M Coding:
No 'Standard' Code Applies to Pediatric E/M Services
Select the appropriate code based on the documentation--not the specialty or diagnosis. When it comes [...] - CPT 2013:
Prep Now for Critical Care, Sleep Study Code Changes That Take Effect Jan. 1
New edition of CPT will impact the way you report these pediatric services.If coding critical [...] - Compliance:
OIG to Scrutinize Pediatric Antipsychotic Prescriptions in 2013
Plus: Medicaid audits will determine whether special need school services were medically necessary.The HHS Office [...] - ICD-10:
New 'J' Code Will Replace 034.0 for Strep Throat Dx Under ICD-10
Fortunately, however, coding choices for this condition won't expand dramatically.Your pediatric practice probably sees patients [...] - You Be the Coder:
Avoid Assumptions With Headache Dx
Question: A co-worker says we can submit "headache" and "migraine" on the same claim, but [...] - Reader Question:
Look to Modifier 25 for Nebulizer, E/M Combo
Question: I just received a denial after reporting 99213 with 94664 (Demonstration and/or evaluation of [...] - Reader Question:
Consider Options for New 'Flu Shot Only' Patients
Question: We are trying to decide how to handle new patients who want to come [...] - Reader Question:
'Bullying' Codes Take Back Seat to Main Symptoms
Question: Which diagnosis code should we report when bullying is a factor? We had a [...] - Reader Question:
Know Your 'E' Codes for Anaphylaxis Causes
Question: What do you recommend as the most specific E code for anaphylaxis reaction to [...] - Reader Question:
Get Specific With Pneumonia Dx
Question: Which ICD-9 code should we use for pneumonitis? I had been using "486" but [...]
