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DOCUMENTATION: Coding for Billing

In order to correctly code and bill pediatric child abuse cases, you need to understand the Current Procedural Terminology (CPT) published by the American Medical Association and the International Classification of Disease, Clinical Modification, 9th Edition (ICD-9 CM) published by the World Health Organization. The CPT code tells the insurer "what" was done (i.e. type of visit), and the ICD-9 tells "why" or the diagnosis.

In most office settings, the patient who presents with a child abuse issue or diagnosis is an "established patient." However, occasionally the suspected abuse patient may present as a "new patient" or even as a referral for consultation. Depending on whether the patient is new, established, or a consultation, separate CPT codes are used. In addition, when determining the level of evaluation and management (E&M level for CPT codes), the key components include the history, examination, and medical decision. However, if counseling and coordination of care drive 50% or more of the encounter, time determines the code for the visit.

CPT Codes
line spacer The CPT codes for new patients (99201-99205) and for established patients (99211-99215) are usually at a level 4 or 5 for child abuse encounters. Document each level in order to support the code. Using a template that triggers coding for detailed or comprehensive histories and physicals may assist in the documentation process.

Prolonged Visit
Preventive medicine codes are those commonly used to bill for the annual well-patient visit. Because child abuse encounters often require additional time, use modifiers with appropriate supporting documentation. To capture billing on prolonged visits, add a two digit modifier to the five digit CPT code. For example, add -21(visit takes longer than the usual for well child care) or -25 (dealing with a medical problem or child abuse issue at the same time as the well child exam).

The series 99401-99405 is used for individual counseling. Each incremental increase in code equals 15 minutes of time. Parent-only counseling can be coded as counseling time. Only mental health clinicians can use the psychiatric CPT codes.

Chart Review
If the medical provider is reviewing a chart for Child Protective Service, these can be billed as 99358 (60 minutes) and 99359 (each additional 30 minutes). This is used for prolonged physician service without direct face-to-face patient contact.

Conference or Meeting
A team conference or meeting with Child Protective Services, police, rape crisis counselors, etc. can be coded as 99361 for 30 minutes and 99362 for 60 minutes. For these conferences, document time spent, people present, content of discussion, and plans for the patient.

Continuing Oversight
When there needs to be continuing oversight to ensure that the patient follows through and is protected, the bill should reflect 99374 (less than 30 minutes per month) or 99375 (more than 30 minutes per month).

Telephone Calls
Telephone calls are generally not reimbursed, but can be billed as 99371-99373. If the calls are over 60 minutes, use the 99359 prolonged physician service code.

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Documentation: Overview  Documentation: Documenting the History  Documentation: Documenting the Findings  Documentation: Documenting the Diagnosis  Documentation: Documenting Other Information  Documentation: Photographic Documentation  Documentation: Coding for Billing  Documentation: Additional Resources 

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CPT Codes