Services included in a well-child visit

Each well-child visit should document:

• Health and developmental history (physical and mental)
• Physical exam
• Health education and anticipatory guidance
• BMI percentile (counseling for nutrition and physical activity)
• Anxiety screening (recommended for ages 8-18 years)
• Depression screening and behavioral assessments (at your discretion for children of all ages)

Well-child visit billing

Follow these guidelines to avoid HEDIS^® record audits for well-child visits.

Documenting well-child visit during a sick visit

• When a sick patient comes in and is due for a well-child visit, document all the components of a well-child visit. They can be reported in addition to the problem-oriented visit.
• Documentation must support that both services were provided in their entirety as significant and separately identifiable services. Then report the problem-oriented E&M service with the 25 modifier. This allows us to capture data for the well-child visit and will reimburse for both services.

Sports physicals

If a child needs a sports physical for school and is due for a well-child visit, complete all the services of a well-child visit. Use appropriate diagnosis codes.

New patient preventive visits

Complete and document all well-child visit components and report them.

Ages 0-30 months

• Newborn visit 3-5 days post discharge
• AT 2, 4, 6, 9, 12, 15, 18, 24 and 30 months (at least 6 visits in the first 15 months)
• CPT codes 99381, 99382, 99391, 99392, 99461

Ages 3-6 years

• 1 visit per year
• CPT codes 99382, 99383, 99392, 99393

Ages 7-18 years

• 1 visit per year
• CPT codes 99383, 99384, 99385, 99393, 99394, 99395

Incentives

Well-child visits for 0-15 months, 3–6 year olds and 7-12 year olds are PCP Incentive Program (PIP) measures (login required).

To find patients needing well-child visits: Use the online Patient Profile tool to sort your patients by missed visits.