Pediatric Coding Alert

Look to ‘V’ codes for non-injured patients.

Summer is upon us, which means your patients are outside enjoying the warm weather. But in addition to experiencing good times at the beach and in the pool, children may also face a host of medical issues that are specific to the season. Read on for the top five summer coding questions, with our expert answers.

Bite Down on Tick Removal Code

Question 1: A mother brings her daughter to your office and asks your staff to remove a tick from behind the child’s knee. Should you count the removal toward the E/M visit or charge a foreign body removal code?

Answer 2: The answer depends on the tick’s status and the pediatrician’s work removing it. If the tick hasn’t buried itself, the pediatrician will probably grasp and remove the tick with forceps. In this case, you’d report an E/M code such as 99212.

In another scenario, the tick’s head is buried, but the remainder is free. The parents tried unsuccessfully to remove the tick before bringing the child to your office. You spend 15 minutes attempting to remove the tick with forceps. You remove the tick, but must dig around with forceps in order to do so.

Once again, you’ll report an E/M code and not foreign body removal since the physician didn’t make an incision. Code 99213 should be adequate.

Incision Sets Up Foreign Body Removal: Suppose the tick is more than halfway buried. You attempt to remove the tick with forceps, but cannot. The provider applies topical anesthetic and uses a #11 blade to make an incision to remove the tick. In most cases, you won’t need to perform closure. You can now report foreign body removal (FBR) because you made an incision in order to remove the tick. Report 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) in addition to an E/M code, such as 99212 or 99213. Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional  on the same day of the procedure or other service) to the E/M code.

Consider Coding Injection for Poison Ivy

Question 2: Your physician reports 96372 after administering an injection to treat a patient’s poison ivy and rash (dexamethasone, J1100). Which diagnosis codes apply?

Answer 2: Code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) is the administration code for the medication. You should also report J1100 (Injection, dexamethasone sodium phosphate,  1 mg) to bill for the cost of the product. The associated diagnosis is 692.6 (Contact dermatitis and other eczema; Due to plants [except food]); you’ll notice that poison ivy is one of the conditions listed as covered by the diagnosis.

Note: You will bill an office visit with 96372, append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code.

Include Earwick Placement in E/M

Question 3: The pediatrician saw a patient with swimmer’s ear and placed an ear wick into the ear to place the ear drops. How should you code the ear wick placement?

Answer 3: If the physician places an ear wick into the ear to place the ear drops, you won’t report a separate procedure code to report the placement and should instead include it in the E/M code for the day, which will typically be in the 99212-99213 range for an established patient. You’ll also want to report the ICD-9 code as 380.12 (Acute Swimmer’s ear).

Sunburns May Not Qualify for ‘Burn Treatment’

Question 4: A patient presents for evaluation of a sunburn. Which CPT codes should you report?

Answer 4: Just because a patient’s parent diagnoses a child as “burned” after being in the sun too long doesn’t mean you automatically choose a burn treatment code for the encounter. In fact, most -- but not all -- sunburn cases merit E/M codes.

Example: An established patient visits the office because his mother is concerned about his sunburned back. The pediatrician examines the patient’s back and decides the burn is superficial and will heal on its own in a few days. The physician advises the patient to avoid lying on his back and to wear his shirt while in the sun. She recommends using a topical aloe gel to help relieve pain. Since the physician didn’t spend a lengthy amount of time examining or counseling the patient, and didn’t administer any treatment, the visit leads to a low-level E/M code such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...).

If, however, the physician provides local treatment to the first-degree burn, choose 16000 (Initial treatment, first degree burn, when no more than local treatment is required) for the encounter. A first-degree burn usually only reddens the skin. The patient might have some swelling and mild blistering, but this is normal and usually resolves quickly. Treatment of a burn categorized by 16000 would typically include use of topical medication, such as a topical anesthetic. The physician might also apply bandages to the burned area, but first-degree burns rarely require more than an application of moisturizer to soothe the skin.

‘V’ Codes Work Well for Non-Injured Patients

Question 5: A mother brings in her daughter, who fell on the concrete at the pool while running around it. Your pediatrician evaluates the patient but finds no problems. How should you bill for examining the child who fell at the pool but has no injuries?

Answer 5: If there is truly no injury or report of any complaint, use V71.4 (Observation following other accident). Otherwise, report the chief complaint, such as a sprain of the wrist (842.xx, Sprains and strains of wrist and hand). This visit would typically support a low or mid-level E/M code such as 99213.