Coding Corner

The AAP has lots of ways to find out all the tidbits of information you need to know in order to be a great coder. In today’s tough economic times, you want to be the best coder you can be, in order to get paid for the services you render. Starting with the AAP Website www.aap.org, sign into the member center and click on “Practice Management Online.” A second resource that helps me quite a bit is SOAPM (Section on Administration and Practice Management). Joining is a pittance, and you have instant access to the best practice managers in the country…other pediatricians! There you can join a listserv (it's beneficial to make a new email address for this) and get instant answers to any question on your mind. You won’t be sorry.

Some pediatricians don’t bother to read National AAP coding advice because they claim it not to be New York specific. I feel your pain. Many times I have read advice and known full well that my local payers wouldn’t respond to some billing strategies. In the “Coding Corner” we promise to give you billing advice that you can use which is guaranteed to be in a New York state of mind!

Diagnosis Obesity 278.00

Many physicians tell me that they do not treat obesity, or use it as a lone diagnosis because it is often denied by payers. A recent analysis by our group showed that this code was paid 63 out of 70 times. It seems that payers have finally realized that obesity is a real disease and want us to treat it.

96110 Developmental Screening

I can’t believe how under used this code is! Aside from recent reports that a few large payers will no longer pay for this code, many still will. Use this code with a modifier -59 when in conjunction with an office visit. 96110 is most commonly used with the following NYS approved screening tools: M-CHAT, ASQ (Ages and Stages), PEDS, EPDS (Edinburgh Postpartal depression screen), PSC (Pediatric Symptom Checklist), and Vanderbilt (ADHD Questionnaires).

By Marc Lashley, MD, FAAP (NY Chapter 2)