by Jennifer Mellick, MD, FAAP
“If you didn’t chart it, you didn’t do it.” I remember hearing this as a resident more than once. It is as true today as it was then. Basically, a note is the only way we have to communicate after the fact with other physicians, specialists, and ourselves over time. Writing it down helps to memorialize it. Well, with insurers “if you didn’t BILL it, you didn’t do it.” Most of the time, insurance companies aren’t looking at every note or every chart, they are looking at the codes we send. So make sure if it is important, you bill for it.
Billing is important in more than just physicians getting paid for what we do. This helps us show insurance companies what is important to kids and pediatricians. Even if it is a code that isn’t paid, we should bill for it so we can track it. As the Pediatric Council has furthered our conversations with insurance companies, we have heard that the reason they don’t always pay for a code is because not everyone does that procedure so it must not be important. A couple examples of this are Edinburg depression screens, vision testing for some insurers, developmental and depression screening just to mention a few. It gets even more complex as we get into the new codes coming out surround Telehealth and Telephone care.
One of the best ways I can suggest to keep up to date on coding and billing is to get a copy of Coding for Preventative Care each year.
This little book has updated codes each year for the preventative services that children need.
At our last Pediatric Council meeting we discussed well child care with payors. A couple of the insurers shared their well child visit rates with us and we discussed ways to improve these. Some of the ideas were dependent on the insurers – like incentivizing well visits for members and other relied more on the physician offices – like recalls. One that will continue to be discussed is the ability to get paid for both sick and well care on the same day. This way if a child presents for a sick visit and is behind on well visits, their sick visit can be converted to a well visit and both can be paid. We will be discussing which of the insurers allows this at our next meeting in March. If any KAAP member would like to submit information on whether they can get paid for both well codes and sick visit codes same day we can use that in our discussion.
