The Pediatric Department is one of the most important segments of the healthcare industry. You could be a part of a large hospital chain or run an independent practice. Either way, pediatric medical billing and coding are challenging and need to be approached right.
Pediatrics is a complex specialty that addresses children’s physical, psychosocial, developmental, and mental health. Pediatric management can commence periconceptionally and continue through gestation, infancy, childhood, adolescence and young adulthood.
Pediatric age group can be divided into three main phases – the infancy phase between birth and 2 years of age, the childhood phase from 2 through 12 years of age, and adolescence from 12 through 21 years of age.
Coding for preventive medicine services can be quite challenging especially if it involves pediatric care. Common services that include under this exam are body measurements (length, height, head circumference, weight, body mass index, blood pressure) and an age-appropriate examination and history.
The preventive medicine codes are broadly categorized based on the type and the age of the pediatric patient – New vs Established and are age-appropriate CPT codes.
|NEW PATIENT||ESTABLISHED PATIENT|
99381 – < 1 year
99382 – > 1- 4 years
99383 – 5-11 years
99384 – 12-17 years
99385 – >17 years
99391 – < 1 year
99392 – 1-4 years
99393- 5-11 years
99394 – 12-17 years
99395 – >17 years
Common guidelines to be followed while billing and coding preventive visits:
These services are performed in an effort to promote health and prevent illness and injury.
CPT 99401-99404 should be reported for these services when performed and documented.
Common guidelines to be followed while billing and coding these services:
Common guidelines to be followed
(If both of the above guidelines are not met, report a non-age-specific AI code (90471-90474).
Source: Bright Futures (aap.org)
Your form has been submitted successfully!!