Pediatric Coding Q&a: Expert Advice from the AAP Coding Hotline

For years, the AAP Coding Hotline has been a trusted resource for pediatricians and others with coding conundrums. Pediatric Coding Q&A:Expert Advice from the AAP Coding Hotline is a compilation of the hotline’s “greatest hits,” featuring guidance on everything from coding for specific clinical conditions to applying both common and evolving coding concepts. Readers will also find coding tips peppered throughout the guidance as well as lists of resources for learning more about individual conditions and concepts.

Table of Contents:
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

About the Author :
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.