What diagnosis code should be used when a child, because of behavioral problems, has difficulty sleeping at night?
Depending on the specific diagnosis, consider codes V69.4 (lack of adequate sleep), V69.5 (behavioral insomnia of childhood), 780.52 (insomnia, unspecified), or other codes under 780.5x.
We saw a child, at the direction of the emergency department (ED) physician, for follow-up of bronchospasm after he had been treated in the ED earlier that day. We saw the child again the following day. Should these services be submitted to insurance via paper claims with attached documentation to ensure payment to us?
It should not be necessary to submit copies of progress notes or a hard copy claim because treatment provided in the ED and a physician office is not typically considered concurrent care. The ED physician will submit his or her services using the ED codes; you will submit office visit services. If the payer denies your services, you should appeal the denial with an explanation of the medical necessity of the visits.
What diagnosis code should be used when the patient is seen only for prescription of a prophylactic antibiotic for prevention of malaria for a future trip to an endemic area?
Report code V07.8, other specified prophylactic measure. You can also report code V01.89, as your patient will have an exposure to malaria with travels.
When a child is seen prior to receiving a monthly respiratory syncytial virus (RSV) prophylaxis injection, is it appropriate to report an evaluation and management (E/M) visit plus the immunization administration code 90471?
If a medically necessary and significant, separately identifiable E/M service is performed prior to administration of the RSV monoclonal antibody, it is appropriate to report the E/M service. The level of service reported will depend on the performance and documentation of the required key components (history, physical examination, medical decision making). The RSV monoclonal antibody should be reported with code 90378 and the administration reported with code 90772 (prophylactic injection, intramuscular) because it is not a vaccine. Some payers will require modifier 25 to be appended to the E/M service.
