Coding for Pediatrics 2020

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​Coding for Pediatrics 2020


Coding for Pediatrics, 2020

ONLINE ACCESS

Welcome to the Online Access page for Coding for Pediatrics, 2020.

To purchase the manual, click here.

Coding for Pediatrics is an instructional manual and reference tool for use by primary care pediatricians, pediatric subspecialists, and others involved in the provision of care to children. The purpose of the manual is to support the delivery of quality care to children by providing the pediatric provider with the knowledge to best support appropriate business practices.

Purchasers of the book have full access to the appendices below, accessed via this page with a special access code that comes with the book.

For Online Access to previous editions see: 2019 Edition, 2018 Edition, 2017 Edition, 2016 Edition and 2015 Edition.

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2020 AAPC CEU Quiz
2020 Quiz (No CEUs)

The following are all the links and documents referred to in Coding for Pediatrics, 2020 and additional resources to support your coding needs.

Appendixes

  1. Sample Assessment/Testing Tools 
  2. Vaccine Products: Commonly Administered Pediatric Vaccines
  3. Chronic Care Management Worksheet
  4. Care Plan Oversight Encounter Worksheet
  5. Global Per Diem Critical Care Codes: Direct Supervision and Reporting Guidelines

AAP Resources

AAP Coding Hotline
AAP Coding Webinars
AAP Pediatric Coding Newsletter™ (separate subscription required) 
AAP/Bright Futures "Recommendations for Preventive Pediatric Health Care"
Audit Log
Table 8-1. Evaluation and Management Key Components (Post and Link to file 210)
FAQ: Immunization Administration
Reporting E/M Services with Immunization Administration
AAP Position on Medicare Consultation Policy
Coding Fact Sheets
Standardized Screening/Testing: Developmental and Emotional/Behavioral
RBRVS Brochure for Pediatrics  
ICD-10-CM Pediatric Office Superbill
The Business Case for Pricing Vaccines  
The Business Case for Pricing Vaccine Administration

Links from Manual


National Drug Code (NDC)
Current Procedural Terminology (CPT ®)  general information
      CPT Category II code updates (CPT Category II Codes Alphabetical Clinical Topics Listing)
      CPT Category III code list
ICD-10-CM Code Files and Guidelines (National Center for Health Statistics)   

CHAPTER 2

Assistant Surgeon Procedure Identification  (see Column AA [ASST SURG] in the file applicable to the date of service)
Bilateral Procedure Identification (see Column Z [BILAT SURG] in file applicable to date of service)
CLIA-Waived Tests
Co-surgery and Team Surgery Procedure Identification  (see Column AB [CO SURG] or Column AC [TEAM SURG] in the file applicable to the date of service)
Multiple Surgery Indicators and Adjustments  (Medicare Claims Processing Manual, Chapter 12, Section 40.6)
National Correct Coding Initiative Edits
      Medicaid NCCI website
      Medicare NCCI website

CHAPTER 3

AAP Policy Statement "A New Era in Quality Measurement: The Development and Application of Quality Measures"
CPT Category II code updates (CPT Category II Codes Alphabetical Clinical Topics Listing)
Quality Measure Information
AAP
National Committee for Quality Assurance
Physician Consortium for Performance Improvement

CHAPTER 4

AAP Coding Calculator
AAP Payer Advocacy Templates for Appeal Letters
AAP Payer Advocacy: Letters to Carriers
AAP Pediatric Councils
AAP Hassle Factor Form (AAP members only)
AAP Oops We've Overpaid You: How to Respond to Payer Audits

Payment/Relative Value Units

AAP Resources for Payment
AAP Managed Care Contracting
"Application of the Resource-Based Relative Value Scale System to Pediatrics"  Pediatrics
RBRVS Brochure for Pediatrics
"Understanding the RUC Survey Instrument" video
AAP Code Valuation and Payment RBRVS
Place of Service Code Set

Value-Based Payment

AAP Value-Based Payment
AAP Webinar Series on Alternative Payment Models (scroll down to webinar links)
Accountable Care Organizations (ACOs): General Information
"Accountable Care Organizations (ACOs) and Pediatricians: Evaluation and Engagement" AAP News
"Gainsharing and Shared Savings"
"Pediatric Accountable Care Organizations: Insight From Early Adopters" Pediatrics
"PPAAC: Chapter pediatric councils work with payers on medical home programs" AAP News

CHAPTER 5

AAP Coding Calculator
Program Integrity: Documentation Matters Toolkit
National Committee for Quality Assurance standards for maintenance of medical records
AAP HIPAA privacy and security compliance manuals (AAP member log-in required)
American Health Lawyers Association
Payer Contract Negotiations and Payment Resources
Medicaid RAC program

CHAPTER 6

Documentation Guidelines for Evaluation and Management Services
1995 and 1997 E/M documentation guidelines
American Academy of Pediatrics Pediatric Evaluation and Management: Coding Quick Reference Card
Medicare Learning Network Guidelines for Teaching Physicians, Interns, and Residents booklet

CHAPTER 7

AAP Position on Medicare Consultation Policy

CHAPTER 8

Table 8-1. Evaluation and Management Key Components       (Post and Link to file 210)

CHAPTER 9

AAP/Bright Futures "Recommendations for Preventive Pediatric Health Care"
Behavioral/Developmental Screening (Refer to Appendix I)
US Department of Health and Human Services, Agency for Healthcare Research and Quality, National Guideline Clearinghouse
CPT Category II code updates (CPT Category II Codes Alphabetical Clinical Topics Listing)
Physician Consortium for Performance Improvement
Vaccine Products: Commonly Administered Pediatric Vaccines (See Appendix II)
AMA Category I Vaccine Code Updates
CDC VFC program
Coding at the AAP Vaccine Resources 
      Vaccine Counseling and Preventive Care Visits
      Influenza Vaccines: Coding for the Current Season
      Vaccine Coding Table
      When Is It Appropriate to Report an E/M Service During Immunization Administration?
      FAQ—Pediatric Immunization Administration Codes
      CDC Vaccine Price List
      New Versus Established Patient Status After Vaccine Only Encounter
American Academy of Pediatrics Pediatric Vaccines: Coding Quick Reference Card 2020
National Drug Code (NDC)
Oral Health Coding Fact Sheet for Primary Care Physicians
American Academy of Pediatrics Section on Oral Health state-specific information
What is Included in Preventive Medicine Encounters: Template Letter
AAP "Instrument-Based Pediatric Vision Screening Policy Statement" Pediatrics

CHAPTER 10

Global Periods and Relative Value Units

CHAPTER 11

CLIA Waived test systems and analytes
Centers for Medicare & Medicaid Services CLIA categorization
Individuals' Right under HIPAA to Access their Health Information: Questions and Answers About HIPAA's Access Right  (45 CFR §164.524)
US FDA NDC Directory

CHAPTER 12

Care Plan Oversight Encounter Worksheet (See Appendix IV)
CCM Tracking Worksheet (See Appendix III)
"Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems"  Pediatrics
Boston Children's Hospital Care Coordination Curriculum

CHAPTER 13

Incident-to Billing: Medicare Claims Processing Manual Chapter 12, section 30.6, and Medicare Benefit Policy Manual Chapter 15, section 60 (select "Internet-Only Manuals (IOMs)")

CHAPTER 14

AAP Policy Statement
"Addressing Early Childhood Emotional and Behavioral Problems"   Pediatrics

CHAPTER 15

American Academy of Pediatrics Newborn Coding Decision Tool (available for purchase online)  

CHAPTER 19

CMS-designated global periods, Medicare Resource-Based Relative Value Scale Physician Fee Schedule (See column O)
"Pediatric Hypospadias Repair: A New Consensus Document on Coding")
Medicare Teaching Physician Services rules (See section 100)

CHAPTER 20

American Academy of Pediatrics HIPAA privacy and security manual templates (Member log-in required)
Medicare Telehealth Service List (Medicare Claims Processing Manual, Chapter 12)
Health Resources and Services Administration eligibility analyzer for originating site payment

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