Wiki pediatric billing

[vickytia13]

Hello,

I am currently billing for a pediatrics office and the doctor bills out for codes 97802 (medical nutrition therapy), 83655 (lead testing), 36416 (collection of capillary blood specimen, using a finger stick) and 92587 (hearing test), along with the OV E/M code. But mostly none of the claims are being reimbursed, sometimes they get paid but most of the time they are not. So recently I started putting a mod 59 to the hearing test and med nutrition and got a taxonomy denied note, but when I didn't have the mod 59 the denied note stated that this is an unbundled procedure. How can our practice get reimbursed for the procures that are being done? Is anyone else billing this in their practice?

Thanks in advance

 

[Chelle-Lynn]

First I would look at the benefit of the carriers...are nutritional services a benefit? etc.

However, if they are a benefit, then you need to make sure that you are meeting the criteria for billing these services in addition to the E&M code on the date of service.

For example, 97802 is defined as medical nutrition therapy, initial assessment and intervention, individual face to face each 15 minutes. so the documentation should include;

that this is an initial assessment for medical nutrition therapy (MNT), which includes nutritional diagnostic therapy and counseling services primarily provided by a registered dietitian (RD) for the purpose of managing an acute or chronic condition or disease. This is a time-based code, so documentation must support the time spent on the service.

Generally the fingerstick (36416) is considered inclusive with the E&M or lab service. It would be rare to bill it in addition to the lab or E&M.

In 92587 require the documentation of a limited evaluation is performed using DPEOAEs or TEOAEs to confirm the presence or absence of a hearing disorder. The test is performed using a stimulus and a low noise microphone to record the otoacoustic emissions. A limited evaluation using DPEOAEs involves recording OAE emitted in response to acoustic stimuli using multiple tones, frequencies, and intensities. Alternatively, an evaluation can be performed using TEOAEs, which involves recording OAE emitted in response to acoustic stimuli of very short duration such as clicks or tone bursts. A microphone probe is put in the external ear canal on the side to be tested. The stimulus is applied at multiple frequencies and recordings are obtained. The test is repeated on the contralateral ear. The physician reviews the test results and provides a written report of findings.

My guess is that your office may be using these codes incorrectly which is causing the denial. Is a RD performing the 97802? Are you completing all of the required evaluation and documentation for the 92587? ​

 

[vickytia13]

Thank you for responding and yes we are. We are doing all of the procedures in the office. W have a hearing test machine along with the lead testing kits, The doctor is having a face to face evaluation each time about the medical nutrition along with the office visit.

 

[MADBILLER]

Pediatric Billing

I just read your questions regarding your Pediatiric billing being denied. You may require a -25 modifier on your E & M, especially if vaccines are involved. Remove the -59 on the hearing and it should release your payments. As for the nutritional counseling code add another -25 modifier to it. The 36416 is reimbursable, but it does depend on the carrier (you know because of the allowed amounts), which I believe MAY require a -TC & -26 modifier to, but don’t quote me just yet on the collection code because I’m trying to figure that out on the carriers that won’t release the payment on 36416. For the carriers that do pay on it, NO modifier required. Just remember to bill 85018 Hgb test with the collection code. Hope this helps.