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Well Child Visits.

  1. #1
    Default Well Child Visits.
    Medical Coding Books
    Curious to see what kinds of hits I get on this question.
    If you review the document for a well child, and everything is documented for the well child in the progress notes. But you see a second DX for speech delay.

    Quick abbreviated version of note. At the bottom it reads this.

    Assessment: Healthy Child
    Speech Delay


    Plan: Anticipatory Guidance
    Speech therapist referral


    Would and could you squeeze an an E/M 99212 for the speech delay.

    Meaning your visit would look like this.

    99392. V20.2
    99212.25.315.39


    Let me know your input.

    thank you
    resepectfully
    Daniel
    CPC

  2. #2
    Location
    NCF Gainesville
    Posts
    64
    Default
    I would say no because I am pretty sure that this would be considered part of the well child as far as making sure devlopmentally they are on track. I know when I used to code for Medicaid, they would include items such as this and have a place to indicate a referral was made. If it was something else, sich related like ear infection, then I would say yes. Just my two cents
    Jeni Smith, CPC, CPMA

  3. #3
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    I wouldn't, no. To me it's part of the Well Child visit. It's a childhood milestone, delayed. I'd code the preventive service with the V20.2, speech delay secondary.
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  4. Default well child visit/speech delay
    The provider would have to specifically document that they evaluted the problem and made significant medical decision making on the speech delay.

    Renae Williams, CPC-H
    Outpatient Auditor

  5. #5
    Default
    I agree with Renae. I wouldn't bill the E/M based on the documentation provided.

    Beck627

  6. #6
    Default
    Great direction given by all of you. I left the document, as is. Just a well visit. I was just curious to see how others view this. Happy to see I'm on the same page with all of you.


    Respectfull
    daniel CPC.

  7. Cool two visits same day
    Quote Originally Posted by daniel View Post
    Curious to see what kinds of hits I get on this question.
    If you review the document for a well child, and everything is documented for the well child in the progress notes. But you see a second DX for speech delay.

    Quick abbreviated version of note. At the bottom it reads this.

    Assessment: Healthy Child
    Speech Delay


    Plan: Anticipatory Guidance
    Speech therapist referral


    Would and could you squeeze an an E/M 99212 for the speech delay.

    Meaning your visit would look like this.

    99392. V20.2
    99212.25.315.39


    Let me know your input.

    thank you
    resepectfully
    Daniel
    CPC

    Daniel,

    I have to agree with the response you already got. When coding for a well child visit, several services (including developmental) are included. The only time you can code for a separate sick visit is in the presence of a codition that requires either a diagnostic test to rule it out or requires treatment. For instance, the old "oh by the way...." question at the end of the well child visit regarding the earache, or the runny nose or some other condition that will result in further medical decision making.

    Miguel

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