Pediatric Coding Q&A: Expert Advice From the AAP Coding Hotline

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. The AAP is the largest pediatric publisher in the world, with a diverse list of resources that includes essential clinical and practice management titles and award-winning books for parents.

Introduction
 
Administrative Examinations (including sports physicals) and Forms
Sports Physicals
Examinations Required For Overseas Transfer
Foster Care or Protective Services Check-up
Completion of Forms
Coding Completion of Court Documents
After-hours, Emergency, Weekend or Holiday Services Services Provided on Holidays
Offering After-hours Preventive Visits
After-hours Telephone Service
Nurse Visits During Regularly Scheduled Weekend Hours
Allergy and Immunologic Services
Epinephrine Injector Demonstration
Evaluation and Management and Allergy Testing
Coding a Discontinued Ingestion Challenge
Administration of Oral Diphenhydramine
Asthma
Asthma – Prescription Drug Management
Diagnosing Asthma at Preventive Visit
Coding the Asthma Control Test
Refill of Asthma Medications During Preventive Visit
Inhalation Treatment and Demonstration of Nebulizer
Inhalation Treatment via Metered-dose Inhaler
Attention-deficit Hyperactivity Disorder (ADHD)
ADHD Rating Scales
Date of Service for ADHD Rating Scales
Assessment for ADHD Without Diagnosis
ADHD Follow-up Visit
Rating Scales as Data Elements
ADHD as a Moderate Complexity Problem
Diagnosis Codes for ADHD
Patient Not Present for ADHD Visit
 
Autism and Developmental Pediatrics
Diagnosis Coding for Autism
Adding a Developmental Pediatrician
Autism Screening and Testing
Developmental Testing Time
Developmental Testing and Evaluation and Management Services
 
Behavioral Health
Childhood Grief
Health Behavior Assessment and Intervention
Interprofessional Consultations with Mental Health Professionals.
Discussion of management with Behavioral Health Professional
Counseling for Alcohol or Substance Use
Service Provided Without Patient Present
Behavioral Health Service to Parent
Psychiatric Services by a Pediatrician
Billing and Claims Completion
Downcoding of Claims
Using Modifiers
National Provider Identifiers (NPIs) on Claims
Billing for Locum Tenens
Speaking with Child’s Guardian Ad Litem
 
Breastfeeding and Lactation Counseling
Codes for Breastfeeding Support and Lactation Counseling
Payer Policies for Reporting Breastfeeding Support and Lactation Consultations
Lactation Counseling as a Split or Shared Service
Medical Decision-making: Discussion with Lactation Consultant
 
Burns
Evaluation and Management of Burn
Sunburn
Follow-up of Minor Burn Injury
Follow-up of Burn Injury Requiring Treatment
Telephone or Telemedicine Visit for Burn Injury
Debridement of Non-thermal Burn
 
Cerumen Removal
Cerumen Removal with Irrigation and Instrumentation
Cerumen Impaction Partially Removed
Cerumen Removal
Cerumen Removal with an Evaluation and Management Service
 
Cardiac Conditions
Multisystem Inflammatory Syndrome in Children (MIS-C) Follow-up
Electrocardiography with Purchased Professional Component
Pericardiocentesis
Office Visit for Family History of Ventricular Tachycardia
 
Circumcision
Circumcision with Evaluation and Management Service
Circumcision with Lysis of Adhesion
Circumcision with Complication
Post-circumcision Cellulitis
Circumcision With Physician Supervision
 
Clinical Staff/Nurse Services
Development Screening by Clinical Staff
Tuberculin Skin Test
Reading a Tuberculin Skin Test
Nurse Care Coordinator
Telemedicine 99211
 
Concussion
Complexity of Problem for Concussion
Diagnosis Coding: Concussion Follow-up
Electronically-administered Concussion Test
 
Congenital Conditions
Ligature of Accessory Digits
Neonatal Ear Molding
Ultrasound for Congenital Hip Dysplasia
 
Contraception
Complexity of Problem for Contraception Services
Contraceptive Injection
Contraceptive Prescription at Preventive Medicine Visit
Contraceptive Prescribed as Treatment
 
Depression
Complexity of Problems: Depression and Anxiety
Reporting a Positive Depression Screening
Follow-up of Depression and Other Chronic Condition
Depression and Complexity of Problem
 
Eating Disorders and Medical Nutrition Therapy
Managing Eating Disorders in Complex Illnesses
Nutritional Counseling at a Preventive Medicine Visit
Initial or Subsequent Medical Nutrition Therapy
 
Fever
Febrile Infants
Fever and Streptococcal Sore Throat
 
Foreign Bodies
Ear Tube or Foreign Body Removal
Foreign Body Removal by Irrigation
Foreign Body Removal from Foot
Foreign Body Removal Using a Needle
Attempted Foreign Body Removal
Removal of Multiple Foreign Bodies of Ear
Removal of Earring
 
Fractures
Nursemaid Elbow
Global Care for Radial Fracture
Influenza Immunization During the Global Period
Codes for Supply of Splints
 
Genitourinary Services
Lysis of Adhesions as a Planned Procedure
Labial Adhesion
 
Hearing and Vision
Ear Pulling without Diagnosed Problem
Eye Examination with Fluorescein Dye
Preventive Medicine Visit with Hearing and Vision Screening
Failed Hearing Screening at School
Diagnosis of Failed Newborn Hearing Screening
Vision and Hearing Tests in Evaluation of Underachievement in School
Otoacoustic Emissions
 
Hyperbilirubinemia and Jaundice
Office Visit for Jaundice
Jaundice Suspected at Preventive Visit
Preventive Visit and Office Visit for Jaundice
Level of Care for Hyperbilirubinemia
Office Visit Resulting in Readmission for Phototherapy
 
Immunization Administration
Immunization Administration with Health Risk Assessment
Immunization Without Physician Counseling
Reporting Immunization Administrations with and without Counseling
Reporting Immunization Counseling without Administration
Vaccines for Children and Medical Cost Sharing Plans
Documentation of Immunization Counseling with Administration
 
Integumentary
Worsening Impetigo
Stye of Eyelid with Other Skin Infection
Raynaud’s Phenomenon – Nailfold Capillaroscopy
Incision and Drainage of Multiple Abscesses
Cryotherapy of Warts and Evaluation and Management Service
 
Interpretation and Translation Services
Code for Use of Interpreter Service
Extended Service Time Due to Interpreter or Translator
 
Laboratory Services
Laboratory Tests and Medical Decision-making
Visit to Provide Results of Testing
Influenza A/B Testing
Lipid Testing for Patient on Atypical Antipsychotic
Diagnosis Code for Lead Screening
Diagnosis Code for Titers Order at School Admission Examination
 
Maternal Depression Screening
Procedure Code for Maternal Depression Screening
Reporting Positive Maternal Depression Screening
Maternal Depression Screening and Preventive Service
 
Newborn Attendance at Delivery
Medical Necessity of Attendance at Delivery
Attendance Subsequent to Birth
Attendance at Delivery and Newborn Hospital Care
 
Newborn – Hospital Care
Extended Normal Newborn Care
Normal Newborn Care Throughout Admission
Newborn Same Date Admission and Discharge
Normal Care Versus Hospital Care
Newborn Suspected to be Affected by Maternal Condition
Newborn – Transfer from NICU
Split or Shared Visits
 
Newborn – Critical or Intensive Care
Neonatal Definition
Gestational Age and Birth Weight
Normal Newborn and Neonatal Intensive/Critical Care on the Same Date
Newborn Critical or Intensive Care
Transfer Back to Birth Hospital
Interfacility Transfer in Same Group Practice
Split or Shared Neonatal Critical or Intensive Care Services
Newborn Interfacility Transport
 
Newborn Care – Office or Outpatient Care
Newborn Visit – New or Established Patient
Newborn Preventive Care
Newborn Follow-up Weight Check
Under-Immunization of Parents of Newborn
Newborn Code for Screening for Hip Dysplasia
Newborn Umbilical Granuloma
Umbilical Granuloma
Newborns and Transitional Care Management
 
Obesity
Laboratory Testing for Obesity-related Conditions
Preventive and Problem-Oriented Services
Evaluation and Management of Obesity
 
Oral Health
Fluoride Varnish and Evaluation and Management
Consultation for Preoperative Clearance
 
Preventive Services
Preventive Medicine Evaluation and Management Service
Preventive Medicine Services by Residents
Codes for Screening Instruments
Multiple Standardized Screening Instruments
Preventive Screenings and Work Relative Value Units
 
Respiratory Conditions
Respiratory Syncytial Virus Diagnosis Code
Respiratory Syncytial Virus Prophylaxis
Office Emergency Care for Respiratory Distress
Diagnosis Coding for Influenza A
Units for Infectious Agent Detection of COVID-19 and Influenza A and B
Same-date Administration of Palivizumab and Influenza Vaccine
Nasopharyngeal/Tracheal Suctioning
Telephone Service for Worsening Respiratory Infection
Telephone Service Regarding Multiple Siblings
 
Social Determinants of Health (SDOH)
SDOH and Medical Decision-making
Family History of Domestic Violence
Identified Need for Childcare Assistance
 
Index