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Pediatric Preventive Visits

  1. Default Pediatric Preventive Visits
    Medical Coding Books
    I have searched for specific guidelines for Pediatric, infant & children, documentation guidelines as to what is required. According to CPT a comprehensive age and gender appropriate Hx and Exam are required but it is not synonymous to the comprehensive E/M and does not require an HPI or CC. Is there something out there that tells us what exactly is a comprehensive age and gender preventive visit is then? I have searched AAP and Medicaid but have not found any guidelines that covers how many elements needed in the ROS and what a comprehensive 1995 exam is that is age and gender appropriate!

  2. #2
    Jan, There isn't really a template for the preventive visits. It is up to the provider to determine what is appropriate for that visit. The AAP does have recommendations for these but the most recent one I could find access to is the 2008:

    There is a grid they put together to tell what kind of things should be checked at what age.

    I hope this helps.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  3. Default
    Thank you,
    I have that table for education, but the provider in question doesn't do any counseling, will examine two or three body areas, and no ROS and is calling it a preventive. Talk about gray area!

  4. #4
    St.Petersburg, Fl
    The American Academy of Pediatrics has what is called bright futures and an entire grid of requirements at what age including lead screening, etc.etc. I think you can contact them and ask for a grid to be sent or download it from their site at this link:

    this link is for how to code for the well child visit:

    they are both pdf files and very helpful.
    They have to do an entire physical including milestones, anticipatory guidance, ok to immunizations etc. The best way to get it across to them is inform them theese are requirements using the work fraud usually gets their attention as well.

    I do pediatrics in our county health department and it helps with educating the physicians on things they don't know.
    Hope this is helpful.
    Last edited by apeck; 05-12-2009 at 08:43 AM.
    Alecia Peck CPC

  5. #5
    Atlanta Perimeter Professional Coders
    I find that the most stringent rules are those promulgated by the State Medicaid programs. If you do not see Medicaid patients, you may still want to access their manual to review their guidelines. Bright Futures is another good resource as mentioned.

  6. #6
    Urbana, IL
    One of our Providers turned us on to a clinical explanation of a Peds comprehensive level through "Manual of Ambulatory Pediatrics, fifth edition" for the available components to meet a comprehensive Hx and exam in Peds preventive services. Though CPT states that the preventive comprehensive Hx and exam is not the same as the problem focused comprehensive; it still requires at least 10 ros, 1 each of PSFH for the Hx and at least 8 BO/OS in the exam based on the e/m guidelines nationally recognized from CMS. I highly recommend this book to anyone trying to figure out how to clinically document a comprehensive Hx and exam for a child. Another great read on the E/M guidelines is the CPT Assistant Article from November 2008/Volume 18, Issue 11. It gives the history of the E/M guidelines and has great info to help educate Providers.
    Dawn Peterson
    Coding Consultant/Billing and Coding Instructor
    Illinois, USA

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