5 Services Pediatricians Forget to Bill For

Betsy Nicoletti, MS

Disclosures

November 01, 2018

In This Article

Providing Care While Arranging Transfer

For a critically ill neonate or child who is being cared for before transfer to a higher-acuity facility, use critical care codes 99291 and 99292. These are time-based codes.

Many physicians and pediatric coders are unaware that they may use critical care codes 99291 and 99292 for neonates and young children when the criteria for critical care are met.

Many physicians and pediatric coders are unaware that they may use critical care codes 99291 and 99292 for neonates and young children when the criteria for critical care are met. CPT says[2]:

Also report 99291-99292 for neonatal or pediatric critical care services provided by the individual providing critical care at one facility but transferring the patient to another facility. Critical care services provided by a second individual of a different specialty not reporting a per day neonatal or pediatric critical care code can be reported with codes 99291, 99292.

Document the time in caring for the critically ill baby or child before the baby is transferred, and use these critical care codes to report the service. For a neonate, the receiving hospital will report the per day critical care codes.

Don't Overlook Billing for In-Office Procedures

It is easy to forget to bill for procedures done during a problem-oriented visit or a well-child visit (Table 2). Wart destruction, cerumen removal, nebulizer treatment and medications, and silver nitrate for belly button treatment in the newborn can be forgotten. There is also a code to use when staff demonstrate or evaluate patient utilization of a nebulizer. When these are done, they should be billed in addition to the other service provided. Append modifier 25 to the problem-oriented visit or well-child visit.

Table 2. CPT Codes for Procedures Done During a Problem-Oriented or Well-Child Visit

CPT Code Description wRVU
17110 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions 0.7
17250 Chemical cauterization of granulation tissue (proud flesh, sinus, or fistula) 0.5
69209 Removal of impacted cerumen using irrigation/lavage, unilateral 0a
69210 Removal of impacted cerumen requiring instrumentation, unilateral 0.61
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes, such as sputum induction with an aerosol generator, nebulizer, metered-dose inhaler or IPPB device 0a
94664 Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered-dose inhaler or IPPB device 0a
CPT = Current Procedural Terminology; IPPB = intermittent positive pressure breathing; wRVU = work relative value unit.

aThe codes with 0 wRVUs are for work done by staff. The practice receives payment for the service, but there are no physician work values.

There are also fracture care codes that are performed in the pediatric office. Some of these are for care of a nondisplaced fracture that doesn't require manipulation but represents the definitive treatment. There is also a code for reducing nursemaid elbow (26460—closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation). Code 26460 has 3.58 wRVUs and includes 10 days of follow-up care.

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