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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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7/23/2014
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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 J7609-J7620 claims will be processed for payment according the auto-adjudication rules contained in the UHC claims programming. This change will be retroactive and will be subject to the timely filing limits of the plan and any state mandates that are in effect.  UHC based its decision to pay claims reporting J7611 and J7613 with no age
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 This month's newsletter
July 2014
Volume 9, Number 10
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In This Issue
Professional Component Services: More Than Codes
When physicians provide diagnostic services, payer policy may dictate not only codes and modifiers to be reported but other important information deemed necessary for proper claim payment.


Transitioning to 10: Documenting Abdominal Pain or Tenderness
Documentation requirement and ICD-10 code selection as pertaining to the commonly reported topic of abdominal pain.


Adaptive Behavior Assessments and Treatment
A review of the current CPT Category III codes regarding adaptive behavior assesment and treatment.


Q&A
ICD-10 delay spurs ICD-11 query; and split/shared services in the office setting.


Oral Health Services Update
New codes for oral health risk assessment as part of the universal preventative services recommendations.


You Code It! (Online Exclusive)
Split service of newborn visit, patient consultation, and circumcision.


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


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• Browse all Transitioning to 10
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• 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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