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Presenting the AAP Pediatric Coding NewsletterTM Online, a monthly coding newsletter from the American Academy of Pediatrics (AAP), providing practical and accurate solutions to answer your most urgent pediatric coding questions.
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Denials to Dollars: Insurance Coverage of the 3- to 5-Day Visit (Online Exclusive)

Excerpt: Changes to payer coverage of newborn preventive well-child visits.
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Breaking news: CMS confirms Oct. 1, 2015, effective date for ICD-10 code set
It's official: The health care industry – including physicians, hospitals, payers and home health agencies – will begin using the ICD-10 code set in place of ICD-9 on Oct. 1, 2015, CMS announced in a final rule issued July 31.

UHC rescinds denials for Albuterol based on age
July 15, 2014
The AAP addressed the issue of denials issued by UnitedHealthcare (UHC) for HCPCS codes J7611 and J7613 (Albuterol, concentrated or unit) based on the patient’s age.  As a result of the clarifications provided, UHC is rescinding its denials for Albuterol based on the patient’s age.
UHC will be changing the age limits for the code range J7609-J7620 to 0-999 years, meaning no age edits will be applied.  Claims reporting
...Read Full Announcement

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 This month's newsletter
September 2014
Volume 9, Number 12
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In This Issue
New AAP Policy Statement: “Application of the Resource-Based Relative Value Scale System to Pediatrics”
The June 2014 Pediatrics includes a new American Academy of Pediatrics (AAP) policy statement (http://pediatrics.aappublications.org/content/133/6/1158.full) that provides an overview of the Resource-Based Relative Value Scale (RBRVS), a review of how the RBRVS affects pediatric medicine, an assessment of relative value units, and other related recommendations. Because most payers base their fee schedules on the RBRVS, it is important to understand how this system is used to assign relative value to services across the spectrum of medicine and the related Current Procedural Terminology (CPT®) codes. The policy recommendations follow (CMS is the Centers for Medicare & Medicaid Services; RUC is the American Medical Association/ Specialty Society Relative Value Scale Update Committee):

Newborn Preventive Care: Revisiting the 3- to 5-Day Visit
Codes and guidelines for the initial newborn well-child visits are reviewed with examples and scenarios.

Transitioning to 10: Newborn and Infant Visits
Common newborn and infant ICD-10 codes are covered, including birth weight and gestational age codes, and maternal health codes.

Athma ventilation; CPT codes for influenza vaccines

You Code It!
Complications from constipation are explored along with phone consultation.

2015 ICD-10-CM: The Freeze Continues
Update on the ICD-10-CM code freeze and implementation.

Denials to Dollars: Insurance Coverage of the 3- to 5-Day Visit (Online Exclusive)
Changes to payer coverage of newborn preventive well-child visits.

AAP Pediatric Coding Newsletter™, September 2014 Quiz (Online Exclusive)
Quiz for AAPC Continuing Education Units

Newsletter Features
• Browse all Transitioning to 10
• Browse all Denial Den
• Browse all Q&A
• Browse all Modify What?
• Browse all Online Exclusives
• Browse all Practice Management Tips
• Browse all You Code It!
• Browse all Coding Basics
Note: Given the relative frequency with which code and valuation revisions occur, some AAP Pediatric Coding Newsletter™ Online archived articles may not reflect the most current information available. While we make every effort to update articles or retire those no longer relevant, the volume and frequency of code and valuation revisions may result in some archived material being temporarily out of date.
Because the American Academy of Pediatrics (AAP) is not able to verify the accuracy of the facts relating to a patient encounter, we cannot be held responsible for any coding decisions that you make based on the guidance you receive from the AAP. It is your responsibility to only code for what you do during a patient encounter.

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