Wiki Coding for Well Child Visits

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lopezk89

lopezk89

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Coding for a well child check up having issues with the subsequent visit they are denying the v20.2 and the v70.0 saying not medically necessary I need to know how to code these to get them paid . The Ins. I am dealing with is salud.HELP Please the child is also a new baby. :confused:
 
lopezk89 said:
Coding for a well child check up having issues with the subsequent visit they are denying the v20.2 and the v70.0 saying not medically necessary I need to know how to code these to get them paid . The Ins. I am dealing with is salud.HELP Please the child is also a new baby. :confused:
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What subsequent visit?

If a problem was uncovered during the well check that necessitates a follow-up, code the second visit with the problem diagnosis and an office/outpatient E/M. It wouldn't be medically necessary to call them back into the office to tell them that all of their routine test results were normal; nor would it be medically necessary to bill a separate E/M if you had them come back another day to receive services that should have been done in conjunction with the well check.

Hope that helps! ;)
 
Yes but:)

I guess I am confused as to when they have the come in at 1 month 3 months 6 months and then 1 year and they are just for routine check ups and there is nothing wrong but the insurance is telling them they need to come in for this as well. We do not do immunization here in our office so that would not be an option for a visit. Sorry I just don't know ...:D:eek::)
 
lopezk89 said:
I guess I am confused as to when they have the come in at 1 month 3 months 6 months and then 1 year and they are just for routine check ups and there is nothing wrong but the insurance is telling them they need to come in for this as well. We do not do immunization here in our office so that would not be an option for a visit. Sorry I just don't know ...:D:eek::)
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Oh...okay. Well the 'no immunization' thing might be throwing a wrench in your plan, especially if they're going to another doctor to get that done, and that doctor is, in turn, billing a preventive E/M. If you're doing everything else, such as the routine screenings (hearing, vision, developmental), then you might have grounds for appeal, if you can show that you're following CDC/AAP recommended guidelines, but be warned: many commercial payors have specific criteria that must be met before a well child check is considered a well-child check, and they typically include immunizations. If it's impossible for you to start doing those in your facility, then you may need to leave the well checks up to the pediatrician who is doing the shots. They won't pay 2 providers to do what one can accomplish alone.
 
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