Preventive services and screenings are important, especially for our little ones. Hence, the federal amendment to Medicaid Act’s pediatric standards of coverage for children and youth under the age of 21, called Early and Periodic Screening, Diagnostic and Treatment (EPSDT).
EPSDT was designed to ensure that, regardless of where they live, low income children in the United States can obtain ongoing assessment and, if problems arise, care and treatment that recognizes 21st century standards of care. It was prompted by the shockingly high 50% rejection rate for 1962 Vietnam draftees due to untreated childhood illnesses.
EPSDT is crucial for the health and wellbeing of children everywhere. But, it can pose some concerns for auditors. For example, some of the codes for routine health examinations distinguish between “with” and “without” abnormal findings. And, code assignment depends on the information that is known at the time the encounter is being coded. For example, if no abnormal findings were found during the examination, but the encounter is being coded before test results are back, it is acceptable to assign the code for “without abnormal findings.” When assigning a code for “with abnormal findings,” additional code(s) should be assigned to identify the specific abnormal finding(s). This is where things get tricky when it comes to preventive care. But we all know there are plenty of other confusing areas in pediatrics.
Other areas of concern are:
- Acute care OV
- Neonatal care
- Ancillary Services
Tune into our upcoming webinar, How to Navigate Common Pediatric Coding Mistakes, where we’ll discuss common areas of concern in a pediatric practice and how to prevent pitfalls in preventive services and much, much, more!
Charla Prillaman
Charla Prillaman
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