In a pediatric practice, optimizing the services we bill for can help capture additional revenue, which supports practice sustainability and growth. Below are the top 10 CPT codes to consider, with descriptions of how they may be implemented for better revenue capture:
- 99381-99385 / 99391-99395 – Preventive Medicine Services (Well Child Visits)
- These codes cover routine well-child exams for both new (99381-99385) and established (99391-99395) patients by age. Billing for these exams ensures regular follow-ups and allows for early identification of potential health issues, encouraging preventive care and adding steady revenue.
- 96110 – Developmental Screening
- This code is for standardized developmental screening using tools like the Ages and Stages Questionnaire. Billing for 96110 during routine visits identifies early developmental issues. It is reimbursable separately and enhances patient care while adding revenue.
- 90460 / 90461 – Immunization Administration (with Counseling)
- These CPT codes cover the administration of vaccines when there is physician counseling. Using these codes when administering multiple vaccines allows you to maximize reimbursement for time spent educating parents.
- 96127 – Brief Emotional/Behavioral Assessment
- This code is used for brief assessments for ADHD, depression, or anxiety. Billing for behavioral health screenings adds value to patient care and provides another revenue stream. These assessments are often required during well visits, making them easy to incorporate.
- 99212-99215 – Established Patient Office or Other Outpatient Services
- For established patients with acute illnesses or follow-ups, appropriate use of the 99212-99215 range, depending on complexity and time, can capture revenue for sick visits and follow-ups not included in well-child visits.
- 99050 / 99051 – After-Hours and Weekend Visits
- These codes can be billed when seeing patients outside regular office hours, adding reimbursement for providing extended access to care. Pediatric practices can use these for urgent visits on weekends or evenings, which parents highly value.
- 99354 / 99355 – Prolonged Services with Direct Patient Contact
- When a visit extends beyond the typical duration, these codes cover prolonged time spent directly with the patient. For complex cases, especially for chronic illnesses or intensive family counseling, these add reimbursement for the additional time invested.
- 92551 / 92552 – Hearing Screening
- Pediatric hearing screenings during well visits are billable and valuable for early detection of hearing issues. Routinely using these codes adds minimal time but enhances revenue and patient outcomes by identifying hearing issues early.
- 99173 – Vision Screening
- Similar to hearing tests, vision screening is essential in a pediatric setting. Adding CPT 99173 to well-child visits improves preventive care, making it easier to identify vision problems in children.
- 99241-99245 – Office Consultations
- These consultation codes, if used correctly, allow pediatricians to consult on specific issues for new or existing patients referred by other providers. Although often restricted by payers, these codes can add significant revenue in practices where consultative services are frequent.
Final Tips for Maximizing Revenue:
- Ensure documentation is thorough and supports each billed service.
- Utilize modifiers appropriately to avoid denials, especially when billing for multiple services during the same visit.
- Educate front-office staff to confirm insurance eligibility and verify the benefits for preventive and routine screenings, minimizing denials and maximizing collections.
By incorporating these top CPT codes into daily operations and ensuring appropriate use, pediatric practices can enhance revenue streams while continuing to provide high-quality, comprehensive care to their young patients.
