Primary Care Coding Alert

Are you forgetting to code any -extras- during well checks? If you-re not clear on the associated services you can code outside a preventive medicine service, you could overlook charging many ancillary services. "The American Academy of Pediatrics recently issued new age-appropriate preventive medicine guidelines," says Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville. The Bright Futures Guidelines recommend evidence-based periodicity for history, measurements, sensory screenings, developmental/behavioral screenings and procedures. Here's what you can capture in addition to the preventive medicine service code (99381-99385, New patient preventive medicine service; 99391-99395, Established patient preventive medicine service). Include History, Measurements, Exam in Well Check You take history and measurements at all preventive medicine services, except neonatal, "which are giveaways, pure and simple. The history and measurements are part of the preventive medicine code and cannot be billed separately," says Herschel R. Lessin, MD, vice president and clinical research director at The Children's Medical Group in Poughkeepsie, N.Y. Exception: Your history uncovers a specific problem, Lessin says. In this case, you would need modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to bill a separately identified and documented E/M service (99201-99215, Office or other outpatient visit ...). Heads up: The added body mass index (BMI) recommendation starting at age 2 means you may report an additional ICD-9 code. Use the BMI percentile to choose the correct V85.5x code. For instance, you would represent a 3-year-old girl's 10 percent BMI with V85.52 (Body Mass Index, pediatric, 5th percentile to less than 85th percentile for age). Similarly, you would include the examination in the preventive medicine service. Code Out Sensory Screenings CPT does not include ancillary services and screenings in the preventive medicine service codes. Therefore, you should separately report any vision or hearing screening. Red flag: You should not, however, separately code the risk assessment, such as using informal questions to assess for vision or hearing problems that the guidelines recommend providing at preventive medicine services, in which screenings aren't indicated. If your risk assessment resulted in a positive, meaning the child required screening, you would then code the appropriate sensory screening code. Report Standardized Testing The guidelines break developmental assessment into two portions: 1. Surveillance, which "is a flexible, ongoing process where knowledgeable professionals perform skilled observations of children during the healthcare visit," according to the manual for Tennessee AAP's EPSDT (Early and Periodic, Screening, Diagnosis and Treatment). When you provide and document surveillance often through an age-appropriate checklist, include the work as part of the preventive medicine service. 2. Screening may arise from an age recommendation or from positive surveillance. If [...]