Diagnsis coding with sick & well visits together

Pediatric coding

I am new pediatric coding and have a couple of questions
1) When you have a preventative visit and sick visit together, shouldn't the only diagnosis for the preventative visit be the V20.2 & the sick diagnoses go on the e/m level?

2) The billing company is saying that modifier 59 needs to be added to a nebulizer demonstation 94664 for medicaid plans? I can't find anything to support this and by the definition of modifier 59, that doesn't seem appropriate.

3) Dr. is doing a developmental test 96110. Guidlines say that this requires an interpretation & report. The test is an ASQ which is scored on the last page & is done by the staff. The only thing the Dr. has for supporting documenting in the note under the Plan it says 'ASQ WNL'. Is this enough documentation?

Thanks!

re: Diagnsis coding with sick & well visits together

Your well visit will typically have a V70.0 or similar screening dx code attached, the E&M service will have the problem diagnosis attached to it, with a modifier 25 appended to the E&M (with the disclaimer that I hope documentation supports the use of modifier 25)

re: Diagnsis coding with sick & well visits together

Re #3 - the results need to be documented in the patient's record, no matter who does the scoring. If it's not documented appropriately and you are audited, then it's like it never happened.