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Thread: Need help. Pedatric Expert Please.

  1. #1
    Join Date
    Apr 2007

    Default Need help. Pedatric Expert Please.

    AAPC: Back to School
    I work for a multi - specialty practice. And besides Family Practice, ENT, and OBGYN, and so on. There's PEDS. We still do things here the old fashion way, by just coding off charge tickets.

    My question is, what are diagnosis that trigger a PEDS expert to pull notes to see if they can up the level. Being that these are kids, my perspective is different then would I be looking at a ticket for Family Practice. Don't think the criteria for kids vs adults is the same. Seeking to improve my practice.


    Daniel CPC

  2. #2
    Join Date
    Apr 2007

    Default I hope I can help

    I spent 8 years in peds doing coding and billing for a pediatric practice in the Guilford County Area of North Carolina. I know work in hospice. You can contact me at (336) 331-1272 and maybe I can help you.

    Elizabeth Comma-Watson, CPC

  3. #3
    Join Date
    Apr 2007
    Temple, TX

    Default Pediatric Expert

    Hello Daniel,

    I have been coding Pediatrics for almost 4 years now. First we started off with Superbills and just pretty much data entering...

    Now all progressnotes are on the computer and the computer system pulls the E&M depending on what was documented and we audit the record to ensure the correct level was chosen.. Of course the computer does not read minds and therefore, if the provider does not select New/Established/Consult, the computer will select an established E&M and loose big bucks...

    Anyhow, to answer your question. I almost want to say that coding off a Superbill/Chargeticket is not a good idea anymore. We audit charts and upgrade or downgrade the encounter depending on the documentation. It also is better because we can educate the providers and let them know what might be missing,( like a short procedure note, when they just mark a procedure by a simple click). Therefore things are caught before an insurance company audit and fraud can be avoided.

    Hope this helps.
    The Oracle

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