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Aspects of Proper Billing Techniques in Pediatrics

Aspects of Proper Billing Techniques in Pediatrics

It is important that each Pediatric group utilize proper billing techniques. With a wide variety of billing codes and techniques out there, it is very easy to become confused on the proper billing techniques. This is why this article takes a look at some of the different choices in Pediatric Medical Billing Code and protocols that pediatric services use for billing.   Each visit, the pediatrician and other providers need to select the service/procedure provided as well as the diagnosis of the patient.

The ICD Code for Diagnosis

One of the most prevalent choices in pediatric medical billing codes, the ICD stands for International Classification of Diseases. This is a list of alphanumeric codes that are used to classify a diagnosis. The way that this works is by reporting the code that relates to the diagnosis. In addition to the primary code, it is also a good idea to look into secondary billing codes that can paint a wider picture of the affliction.  For all visits to a Pediatric office through 9/30/15, the appropriate ICD9 codes needed to be attached to each procedure.  Starting 10/1/15, ICD10 codes are attached to each procedure.  After selecting the diagnosis associated with the visit, the provider needs to select the services/procedures performed.  This service is captured in the CPT code.

The CPT Code

The other code used Medical billing has been developed by the American Medical Association and is also known as the Current Procedural Terminology. This is a code that can be used to label any distinctive test or procedure or service.   Each CPT code needs the appropriate ICD code attached to insure payment.   A skilled billing team needs to evaluate the diagnosis and CPT codes prior to submitting to the insurance company.

After Coding, What Next?

As we have seen in the former two sections, there are two distinctive choices when it comes to Pediatric Medical Billing Codes. In this section, we take a look at the basic procedure for billing payments that are followed in medical facilities everywhere in the country.

Verification: The first and foremost step in the billing cycle is to identify the code correctly along with the patient details. Since the codes have a different valuation for every procedure, it is a good idea to make sure that the code on the bill matches the procedures. Additionally, it is important to look into the insurance plans of the patients as they determine whether or not modifiers can be used.

Checking for Claims and Charge Captures: While billing, it is also crucial to check that every procedure has been coded correctly. This follows from the previous point regarding verification. Basically, this stage requires careful scrutiny and it is also important to take note of any claims that have been made. In cases of claims, the same is to be submitted to the clearing house for approval.

Applying the ICD-10 and CPT Codes for Reimbursement: After the procedures have been tagged and approved, the next step involves checking for and applying the ICD-10 and appropriate CPT codes. This is done so that the claim can be reimbursed. As with every other financial transaction, it is important to check the details of the claim edits/rules associated with the insurance company.

When it comes to proper billing techniques by pediatric practices, the best way to avoid any excess error in payment is by keeping a keen eye on the particulars of the bill generated. Along with the right code, one must keep in mind the various tenets of the ICD-10 codes so that practices can receive their much needed reimbursements. Overall, being prepared and aware of the particulars can make the entire medical experience smooth and efficient.  Choosing the ‘right’ medical billing partner is critical for consistent billing performance of a practice.