Seven Reasons Why You Don’t Want To Miss This Pediatrics Practice Management Seminar

My friends at the Pediatric Practice Management Institute (PMI) have an awesome seminar that you don’t want to miss.

Why should you not miss it?

Glad you asked.

I have lucky number 7 reasons why you should not miss this seminar.


I know awesomer is not a word. But it gets’s the point across. Here is the deal, no matter how experienced you are at managing a practice, there is always something new you can learn.


Managing a private practice can be a lonely world. There aren’t that many of us. And most of the time we are locked up in a back room (used for both your office and storage) trying to figure out how to keep the ship afloat.

Without exposure to a variety of points of view, you will miss new ideas and trends that can impact future results.


Paul and his team at PMI have put together a superb curriculum. The educational materials will certainly expose you to new ways of managing your business (e.g., private medical practice) and help you discover how to be more productive.


Here is the way I see it. The practices that tend to go to practice management seminars are precisely the practices I want to learn from. And PMI’s seminar provides a great opportunity to network with the best practice in the country.


Not only will you have access to a community of like-minded people that have similar struggles, have similar challenges and practical, hands-on advice, suggestions, and solutions, you will also have access to the industries top consultants.

Don’t tell them I said this, but if you ask the right questions, to say… Chip Hart, I bet you, you’ll get thousands of dollars worth of practice management advice for <ahem> free.

Keep in mind that experts in the field are some of the best people for you to get to know if you want to learn more about the current health care business climate as it relates to small, private, independent, pediatric practices.


You will undoubtedly discover innovative ways to help your practice remain competitive in today’s fast-paced, hectic private-practice.


Did I mention it was in Vegas?

All work and no play can get old fast. PMI’s conference can add a layer of enjoyment to managing your career growth by mixing a social aspect into your learning and industry branding efforts.

Never underestimate the power of a little fun mixed with some interesting people!


Use the promo code “PediInc” and save $75 off your conference fee.

Conference Details:

  • WhenFriday, January 29, 2016 at 2:00 PM –  Saturday, January 30, 2016 at 5:00 PM (PST)
  • WhereTropicana- Las Vegas
  • Sign Up: Click on the Eventbrite logo below to sign up

Don’t forget to use the promo code PediInc to get $75 off

10 CPT Codes You’re Most Likely Under-utilizing

I found myself sitting next to four pediatricians during the hospital’s pediatric departmental meeting. The four docs were engaged in conversation by the time I sat down at the round table.

They were talking about coding. Specifically about 99213 and 99214. “Do any of you bill level 4s?” asked the one sitting across me. ” I can’t remember the last time I coded a level 4. I just don’t have that many emergencies,” replied the doc next to me.

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The pediatrician that sat across from me followed up in a justifying manner stating, “I keep it simple… level 3 all across the board. I don’t want to raise any red flags with the insurance companies.”

Judging by their nods, all four pediatricians seemed to agree.

Except for me, of course. But I couldn’t say anything because I was recovering from the feeling you get when somebody scratches their nails across a chalkboard.

You’d be hard press to find a cardiologist or orthopedist say; I keep my coding simple so that I can stay under the radar. But pediatricians are, well, pediatricians. And because of who they are and what they do, they are notorious for under-coding (most of them).

But that doesn’t mean we should give up on pediatricians. If anything, we should be motivated to work extra hard to get the word out on proper coding.

Below I’ve highlighted commonly underutilized codes in pediatrics; including level 4 and yes, level 5 (did you even know there was a level five?) in the hopes you or your staff will become aware of these codes and remember to use them.


According to the AAP, 99214 and 99215 (established patient office or other outpatient services) represent only 20% and 5%, respectively, of all evaluation and management codes submitted in pediatric claims.

What does this mean? That most pediatricians don’t code/bill for level 4 or 5s despite having done the appropriate work.

Don’t be afraid of coding level 4 and 5s. If you follow the requirements set forth by CPT and document the chart accordingly, you’ll realize levels 4 and 5 reflect your work with the patient more than a level 3.


If so, you can bill for consult codes 99241, 99242, 99243, 99244, and 99245 ( office or other outpatient consultations)

You may overlook consult codes because pediatricians are not specialist. However, a surgeon, for example -with all their specialized training – won’t even give a kid Tylenol without clearance from their primary doctor. Thus, pediatricians are indeed consultants.

There are a few requirements to bill this code. For example, follow-up with the requesting physician (i.e., the surgeon) with a written report or a hospital’s standard pre-op form.


As the doctor places her hand on the doorknob after completing an exhausting well-visit, she ask the parent, “…is there anything else?”

The phrase, is there anything else? is doctor code for, we’re all done here, I got to go. For the parent, it’s an invitation, of course. What else would it be?

“There is,” says the mom. ”

If you decide to address the issue right then and not ask the parent to come back, you are performing two significant, separately identifiable evaluation, and management services during the course of a single visit.

Therefore, you should attach modifier 25 to the office or other outpatient service code and list that in addition to the preventive medicine service code.

An example of this is preventive medicine service with an acute swimmers’ ear.The preventive medicine service may be linked to Z00.129 while the office or other outpatient service may be linked to H60.339 (swimmer’s ear, unspecified ear).


Do you see patients on a scheduled holiday? Do you see patients late into the evening? How about on Sundays? Do you see patients on Sundays? If you answered yes to any of these questions, you could code 99051 for every visit in addition to the E&M code.

CPT defines this code as service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic services.


Nursemaid’s elbow is a common occurrence in the pediatric population. Do you know that you can code for the treatment of it?

Code 24640 (closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation) may be reported as well as an evaluation and management code if a significant, separately identifiable evaluation and management service is provided.

If this is the case, attach the modifier 57 (decision for surgery) or the modifier 25 (significant, separately identifiable E/M service) to the associated evaluation and management code.


Case management is a process whereby a physician is responsible for direct care of a patient and for coordinating and controlling access to or initiating and/or supervising other health care services needed by the patient.

Sounds complicated. But it isn’t.

Do you spend time on the phone with parents? How about emails or portal messaging?

If you spend a lot of time communicating with parents, either on the phone, email, portal or phone app, you can bill for case management codes.

Although the chances the practice will receive payment for these codes is slim, coding experts and practice management consultants insists it is still a good idea to bill for what you do.

Therefore, whether you communicate with the patient via phone (99441-99443 or e-mail 99444), you are providing care for the patient and should bill for your services.


Let’s say a mom brings her daughter in because she suspects she is a victim of child abuse.

According to the APP, the pediatrician is required to perform a complete evaluation and management service in addition to an anogenital exam with colposcopic magnification.

With an example like this one, you should report both the evaluation and management service and the colposcopy. For the anogenital exam, use code 99170.

Don’t forget to add modifier 25 to the evaluation and management code to “alert” the insurance processing the claim the fact that you performed a significant, separately identifiable evaluation, and management service in addition to the colposcopy during a single visit


Have you received a call from a parent at the end of the day asking if her child can be seen? And because you can’t bare the thought of the child suffering for another 12 hours or feel guilty telling the parent to go to the ER, you and a few staff members end up staying after regular office hours to see the child?

If it has happened to you, make sure that you are billing for 99050 in addition to the E&M code

This code is for services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed.


Imagine for a moment that instead of a mom calling your office at the end of the day, she shows up mid-morning with a wheezing kid.

Do you see that patient right away, essentially on a “walk-in” basis and make all other patients wait?

If you do, you should be billing for “service(s) provided on an emergency basis in the office, which disrupts other scheduled office services” (99058) in addition to the evaluation and management code.


Do you screen or ask parents to complete forms that aid in the assessments of a child’s development? For example, manage developmental screening tools such as Developmental Screening Test II, Early Language Milestone Screen, PEDS, Ages and Stages, and Vanderbilt ADHD rating scales?

If so, you should be reporting it using CPT code 96110 (developmental testing; limited) or 96127 (brief emotional/behavioral assessment)

Keep in mind that the purpose of this post is to bring to your attention a handful of codes that pediatricians don’t use as often as they should. I’d suggest finding coding and billing resources that go in depth into each of the codes supplied in this post, as well as provide a plethora of other underutilized code.

#20 Key Performance Indicators Smart Practice Managers Measure [Pediatric Practice Management AwesomeCast]

Screen Shot 2013-11-07 at 7.42.08 PMFor today’s AwesomeCast, I invited my friend Paul Vanchiere from the Pediatric Management Institute. Apparently, Chip had more important things to do… Pfff. Family. So he was MIA for this recording.

If you don’t know about the Pediatric Management Institute, make a note to visit. Paul and his team are doing some really cool things to help pediatric practices manage their business better.

Paul knows a few things about key performance indicators, why they are important, and most important, how to calculate them. So I sat down with him and asked him a few questions regarding the topic.

On the AwesomeCast, Paul shares with us an area on his website where you can find explanations, formulas, examples and descriptions for all the key performance indicators.

For details check out this link: Calculators – KPI 

And if you want to learn about the seminars Paul and his crew is doing around the country, visit: PMI Seminars

Here are other ways you can check out the AwesomeCast:

Want To Improve Profitability for Your Medical Practice?

574463_origWhen in comes to increasing profitability, I see practices focus their efforts in collecting copayments and patient balances. Others look towards decreasing cost, like buying cheaper paper or going with a cheaper merchant vendor to help boost the bottom line.

Both, of course, are important exercises for a business. But here is what I’ve noticed. There doesn’t seem to be an equal amount of energy put towards learning about medical coding and how it can have a significant impact on a practice’s numbers.

Here is a truth. Money isn’t always lost when the patient is at check-in, or when a claim is submitted, or even when a practice buys paper at $40 a bundle instead of $35.

Money is most likely lost inside the examining room as a result of poor documentation, which leads to poor coding.

Now, billers and coders are usually on the ball with their practice’s billing and coding. They are familiar with the plans, how much each pays, how claims must be submitted and things like that.

When I talk about the need to focus on billing & coding, I’m talking about medical coding training for physicians/providers.

I have a friend who’s been in practice management consulting for 20 plus years. He once told me that medical practice’s call him in so that he can assist them in negotiating  better payment from the payers because they believe it is the way to increase revenue for a practice.

Upon reviewing their numbers, my consultant friends often discovers that the doctors in the medical practice are doing a poor job of coding.

By explaining how to document and code properly, he is often able to boost each doctor’s revenue between 20K to 30K dollars. If the practice has four pediatricians, that translates between 80K to 120K more a year merely by learning how to properly document for the work that they are already doing and coding accordingly.

I’m not suggesting, by the way, that a practice should not try to negotiate with payers for better payment.  But rather pointing out that in many practices, medical billing and coding training is an overlooked activity that can be can boost the bottom line for a practice.

If you are a provider, and don’t attend coding seminars regularly, start going to at least one coding seminar a year.

By the way, I know many practices have coders and biller that do a lot of the work for the providers as it relates to coding. And that is great.

But a provider that knows how to document a chart properly, to get the most for the work he or she does, goes a long, long way towards the profitability of the practice.

Before you let me go, please select the statement that best describes what you were thinking as you were reading this post:

  • I don’t have time for seminars.
  • My practice can’t stop seeing patients for a day.
  • That coding stuff is overrated.
  • I have “people”  that do all that coding stuff for me.
  • I know everything there is to know about coding.
  • I already went last year to a coding seminar, I don’t need to go again this year.
  • I only need to know how to code a level III.
  • In pediatrics nothing merits more than a level III, what good is it to learn the rest.
  • ICD9 is gonna be obsolete. I’m holding out for ICD10
  • I didn’t go school to learn medical coding.

… if one or more of these statements (or any variation of) crossed your mind while you were reading this, then let me tell say, that you are the one that needs to attend a coding seminar the most.

#8 Key Metrics We Should Use to Gauge the Financial Health of Our Medical Practice, Part II [Practice Management VideoCast]

Chip and I continue our discussion on key reports we ought to be looking at when assessing the financial health of our practices.

In this AwesomeCast, Chip and I talk about E/M distribution, specifically the 9921x and how looking at these CPT codes and comparing with each other can provide a lot of insight into the clinic’s billing practices, among other things.

We also talk about Sick to Wellness ratio. Chip walks us through his process on determining the sick to wellness ratio and what are the sort of things this report tells him about a practice.

As always, we’ve made the AwesomeCast available in various formats. Check out the links below and find the one that best suits you.

1. Google+ Community

2. Pediatric Practice Management Mediacast PodCast

3. iTunes

And of course, YouTube:

10 Ways to Find Ways to Improve Your Medical Practice

We often forget about improving things in our medical practices. We get comfortable and complacent. We often assume, we do a good job, no need to fix what isn’t broken.

But time and time again, I’m reminded that there is always areas of improvement. I’m also reminded that on occasion, we don’t do things as good as I see them in my mind.

The problem for many is that because we are so used to doing things the way we’ve always done them, it is hard to step back and look at things from a different perspective. It is like reading something you’ve written 20 times and then giving it to someone to proof read it for you and then they find 3 mistakes in the first line. C’mon, how could I have missed it? I READ IT SEVERAL TIMES! I often scream.

With that in mind, I’ve put together a few ideas or tips that will help you see things differently in an effort to show you ares of improvement.

  1. Send a message, as if you were a patient or prospective patient to the email on the website and see how long it takes to get an answer.
  2. Call the practice. Act as if you are a prospective patient/customer and see how the front desk or receptionist treats you.
  3. Call the billing department and ask them if they could explain all these things in your EOB. Decide if the billing staff is genuinely trying to inform the patient or being condescending, dismissive or simply not helpful.
  4. Pull a patient aside that just checked in, explain that you want to document how long an entire visit takes and ask if they agree to help you with your experiment. Have her write down how long each process takes, including how long it takes from the time she checks in to time she is called in; time it takes the doctor to step in after triage is done; how long does it take to get a refill on a Rx, etc.
  5. Print a patient’s statement and hand it to a relative that knows nothing about medical billing. Ask them if they know what is owed, how to pay the bill or if it is easy to identify where to call if they have a question.
  6. Search Google for each of your docs name as well as the practice’s name. See what comes up.
  7. In Google, type “pediatrics” or Pediatrician and your office’s zip code (or town). Hopefully, your practice will come up. If it doesn’t, you have work to do.
  8. Call several OBs in your area and ask if they know of any good pediatrician’s office in the area. If they don’t mention your name, call later and introduce yourself. You may want send them a pack of business cards too.
  9. Think about this question, If our practice relied solely on donations, what would you do different. Write at least 5 things down on a piece of paper and start working on the things on the list.
  10. Switch place for an entire day. If you are a biller, work the front desk. If you work the front desk, work as a biller. If you are a triage nurse, make appts for a day. Of course, this won’t work for everybody and I’m not suggesting for docs to answer the phones for the day. But the exercise will not only help appreciate others’ roles, but it will also allow people with different perspective take a look at what you do and perhaps find improvements. Much like the person that is reading your draft.

What else? Could you add to this list? What other things can we do to help us identify areas of improvement?

Medical Billing Behind the Scenes

I wrote the blog post below on the Survivor Pediatrics blog titled “What I wish parents Knew about Medical Billing”. I didn’t post it here on PediatricInc because placing it here would have been like preaching to the choir.

To my surprise, the post has gotten a lot of attention and I’ve received a lot of great feedback from people in the healthcare industry (those that actually live this day by day) as well as non-clinical or non-medical people.

So I decided to post a summary here on PediatricInc, not to tell you all what you already know, but rather to enlist you in sharing this message with your community, your audience and your parents.

Below is a summary, but you can check out the entire article by visiting the other pedia-tastic blog Survivor Pediatrics.


At a restaurant, generally you’ll get an itemized check that shows all the things you’ve ordered. Doctors do the same thing, but they do it in the medical chart.

Virtually every doctor who accepts health insurance uses codes (called CPT codes) that are assigned to every task they and their staff performs. Everything from a simple blood draw, to immunizations, to the ear check, to specimen handling — all these things are “coded” separately.


Parents often think when they are looking at the bill that the doctor is nickel-and-diming parents, when in reality, it is the insurance company that requires the doc to show their work in this matter.

The health insurance company doesn’t accept the doctor telling them, “I did a well visit — pay me our agreed-upon fee.” They want to know all the things the doctor did during a patient’s visit so they can decide how much they ought to pay the doctor for his/her services.

Since most patients (or in the pediatrician’s case, parents) don’t pay the doctors directly, but rather the health insurance company, they want to know what took place during the visit so they know how much they ought to pay the doctor.

It is the same as going to the restaurant and getting billed for all the side and extra orders. Although the main meal is accompanied by other things, like french fries or a salad, refills, side orders, substitutions and additions to the order are billed as extra.

Health care services are a la carte as well.


As a practice, we consider that treating patients based on what the insurance covers and what it doesn’t, instead of treating by what the patient actually needs, is an unethical way to practice medicine.

I believe it is  time to start lifting the curtain, showing people what is under hood or giving people a behind the scene tour  on why things are the way they are.

Unless we start telling parents how things are and giving them this insight, they will continue to believe we are the reason the system is broken. We all know that is not true. And we all know who really is to blame.

For the full post, click here