Wiki Well Child Exams: Am I missing something?

[EricaCR]

Our practice owner is asking me to find out if there are things we could be billing that we aren't, particularly in regards to Well Child exams. Currently we would bill:

99393 - main code for whatever the correct age range is
90460 and 90461 - for vaccine administration
99173 - for vision test
96110, 96127, 96160 - where appropriate for various screenings:
(using 25 and 59 modifiers where needed)

Is there any other aspect of the Well Child exam that people bill for that we aren't?

Also, for the screening codes, is it necessary to document the name of the screening and the scores in the chart notes?

Thanks!

 

[Pam Warren]

unless your vaccines are state supplied, you can bill the vaccine CPT code along with the administration. If they're state supplied, you cannot.

Whatever screening you perform and subsequently bill must be documented in the chart. In fact, everything you bill must be documented (if it isn't documented, it didn't happen).

If the well-child check turns up an issue, or if the kid has a complaint at that time, and the provider spends significant additional time evaluating and addressing the issue, you may be able to bill an E&M at the same encounter (with a -25) but the documentation must support additional work and medical necessity. The parent may need to know that this additional add on to the visit won't be 'free' like the well check is.