Pediatric Coding Alert

Theoretically, all coding is supposed to be done by the person treating the child. The diagnosis and procedure codes should be done by the person providing the care, explains Allen D. Schwartz, MD, FAAP, a coding trainer for the AAP. Nobody else knows the work that was done, says Schwartz, who is with FPA Pediatric HealthCare Associates, a 3-physician practice in San Diego, CA.

But in reality, much of the coding is done by office staff -- especially when it comes to patients who are seen in the hospital. Here are some tips for coding retrospectively, something you may not want to do, but when necessary can be done smoothly -- if its done right.

1. Rely on pediatricians notes. I start with the history and physical that should be in the chart, says Wanda Reinecke, office manager for Victoria Pediatrics, Victoria, TX. If any of the doctors see a patient, there has to be a history and physical, she tells us. And if hes put in the details of the symptoms, that makes coding a lot easier. For hospitalized patients, there will also be an admitting summary and a discharge summary, which can be helpful.

2. Get hospital information. If a patient is hospitalized -- and that is where many of the coding gaps are -- you can get some good information from the hospital, Reinecke advises. However, one drawback of this is that the information doesnt come from the hospital until two weeks after discharge, and Reinecke likes to get all the codes recorded and submitted before that.

(Tip: If you do use hospital documentation for information purposes, remember that hospitals use rule-out codes, signs and symptoms for diagnosis codes, and follow with the observation for suspected condition codes. You will have to interpret these codes and apply the appropriate CPT and ICD-9 codes for your office billing in order to be reimbursed.)

3. Dont wait too long to code. If you need to get more information from the pediatrician to fill in the codes, you would be better off getting it done as soon as possible after the patient is seen. Reinecke tries to code all procedures and visits within two days of the date of service. Marilyn L. Schmidt, office manager for Southwest Pediatrics, Palos Park, IL, gets all the codes down within a week of the date of service. If you wait too long, the pediatrician may not recall the details of the service.

4. Talk to the pediatrician. The chart should be your first point of reference when coding. But if you have questions that you cant resolve on your own, its essential that you ask the doctor, Schmidt and Reinecke agree. However, this is a delicate communication issue. I go to the chart first, but if I dont understand what it says, I have to talk to the doctor, adds Schmidt, who works for five pediatricians. Reinecke doesnt ask the doctor about codes until she has consulted with her manual. Our pediatricians want to code for everything they do, which would be great, but we cant do that, she notes. We have to pick the code that gets the highest reimbursement. It upsets our physicians to realize theyre not getting paid for all of the work they do, Reinecke adds. She confesses that it is difficult to code for someone else. Its hard when the coder doesnt personally see the patient, she says. And its really hard when you dont even know the patient, such as when your doctor is covering for another pediatrician.

(Tip: Communication between the physician and the coder is essential. Use each encounter to educate all involved on what can be done to optimize reimbursement through accurate coding.)

5. Use a routing slip for hospital visits. Schwartz has a routing slip for hospitals similar to the superbills used for his office visits. There are five different hospitals here, he tells us. Each hospital has a computer printout with the patients name. We use that as a routing slip for the diagnosis and CPT codes. I made up a form that lists the most common hospital codes, and we attach that to the hospital printout. There are about 25 codes on the hospital routing slip, and it makes on-the-spot coding much easier for doctors doing rounds.