Wiki Well Child Visits

irma011

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Can anyone advise me on whether or not we can bill CPT codes 97802/97803 and 96110 with wellness visit E/M codes? Or would that be considered unbundling components of the well visit? What about the vision & hearing screenings as well? Are those also inclusive with the well visit & shouldn't be reported separately? Thanks in advance!
 
I am in Mississippi and majority of insurance payers follow the Bright Futures Guidelines (recommendations for preventive pediatric health care) put out by the American Academy of Pediatrics. I attached the periodicity schedule. 96110 is covered as part of a wellness visit during an 18 month & 24 month visit. We use the MCHAT assessment for this. We bill it with the well E/M and it is paid. The other 2 codes are not considered wellness to my knowledge. You might want to look at 99401, Preventive medicine counseling, which includes diet. This code isn't covered by many payers though, it's usually rolled into the E/M. Hope this helps.
 

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I am in Mississippi and majority of insurance payers follow the Bright Futures Guidelines (recommendations for preventive pediatric health care) put out by the American Academy of Pediatrics. I attached the periodicity schedule. 96110 is covered as part of a wellness visit during an 18 month & 24 month visit. We use the MCHAT assessment for this. We bill it with the well E/M and it is paid. The other 2 codes are not considered wellness to my knowledge. You might want to look at 99401, Preventive medicine counseling, which includes diet. This code isn't covered by many payers though, it's usually rolled into the E/M. Hope this helps.
Thank you so much!!
 
I am in Mississippi and majority of insurance payers follow the Bright Futures Guidelines (recommendations for preventive pediatric health care) put out by the American Academy of Pediatrics. I attached the periodicity schedule. 96110 is covered as part of a wellness visit during an 18 month & 24 month visit. We use the MCHAT assessment for this. We bill it with the well E/M and it is paid. The other 2 codes are not considered wellness to my knowledge. You might want to look at 99401, Preventive medicine counseling, which includes diet. This code isn't covered by many payers though, it's usually rolled into the E/M. Hope this helps.
I am new to pediatric coding and my providers do MCHAT assessment and the codes are getting denied when billing together with well visit. I am from Oklahoma do we need to attach reports will you please share a few more about MCHAT? TIA
 
I am new to pediatric coding and my providers do MCHAT assessment and the codes are getting denied when billing together with well visit. I am from Oklahoma do we need to attach reports will you please share a few more about MCHAT? TIA
When the MCHAT is done with an E/M visit, modifier 25 is needed on the E/M. If vaccines are done as well then XU modifier is needed on the MCHAT.
 
I am new to pediatric coding and my providers do MCHAT assessment and the codes are getting denied when billing together with well visit. I am from Oklahoma do we need to attach reports will you please share a few more about MCHAT? TIA
I always put modifier 25 on the e&m code, and modifier 59 and 33 on the MCHAT and ASQ screenings. I also add an additional diagnosis 2ndary to Z00.12X of z13.41 encounter for screening for autism for MCHAT and z13.42 encounter for screening for developmental delays (milestones) for ASQ. This is what the AAP 2021 coding guidelines book states. I have never used modifier XU. I do not have any issues with payments.
 
I always put modifier 25 on the e&m code, and modifier 59 and 33 on the MCHAT and ASQ screenings. I also add an additional diagnosis 2ndary to Z00.12X of z13.41 encounter for screening for autism for MCHAT and z13.42 encounter for screening for developmental delays (milestones) for ASQ. This is what the AAP 2021 coding guidelines book states. I have never used modifier XU. I do not have any issues with payments.
Hello, this is Louisiana, wellness code Z00.12x is payable w/o -59 modifier w/MCHAT (z13.41) and ASQ (z13.42) same line @ 2 units, per coding for Pediatrics 2021. Also do not have any issue w/payments... MCHAT & ASQ screenings also payable outside of wellness, is that why you suggest the modifier -25, -59 and -33? will try this, have not been successful at getting this scenario paid. Thank you
 
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