1. Age-Specific Coding Guidelines
✔ Use CPT codes based on age (e.g., newborn care, well-child visits, sick visits)
✔ Document growth, development, and immunization status at every visit
✔ Apply appropriate ICD-10 codes for pediatric diagnoses (e.g., asthma, otitis media, ADHD)
2. Preventive vs. Problem Visit Billing
✔ Use well-child CPT codes (e.g., 99381–99385) for routine care
✔ Bill problem visits separately using modifier 25 when addressed during the same appointment
✔ Ensure proper documentation for both services
3. Vaccination and Immunization Billing
✔ Bill both the vaccine product and its administration (e.g., 90460, 90461)
✔ Verify age and dosage-based coding requirements
✔ Record vaccine lot numbers, site, and consent in the chart
4. Billing for Common Pediatric Services
✔ Include screenings (vision, hearing, lead, developmental) when applicable
✔ Use time-based codes for behavioral evaluations and counseling
✔ Track eligibility for Medicaid EPSDT services
5. Common Challenges & Fixes
| Challenge | Fix |
| Missed modifier 25 with dual visits | Train providers to flag problem-based care in well visits |
| Incorrect vaccine coding | Use cheat sheets by age group and product code |
| Underbilling screenings or counseling | Audit charts for missing services and educate staff |
| Immunization denials | Verify coverage and authorization rules in advance |
