Children with complex medical histories and acute and/or chronic health conditions may present under different circumstances and with different needs than their peers. This article will use a few examples to illustrate scenarios and related coding options for capturing the work of caring for children with complex health care needs. Knowing these coding options and related documentation requirements is key to receiving payment for time and effort beyond the typical evaluation and management (E/M) service.

A 5-year-old boy (new patient) presents with history of congenital heart disease, cerebral infarction that resulted in right hemiplegia, heart transplant 5 years ago, and subtotal cerebral hemispherectomy 4 years ago due to intractable seizures. His previous primary care physician is no longer in network for the child’s health plan. His parents requested an initial visit to introduce the child while he is doing well. The pediatrician completes the age- and gender-appropriate history and physical...

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