Each Well Child Check will include gathering information about the family’s and child’s health history, physical examination (including length, weight, weight for length ratio, head circumference), developmental surveillance, behavioral assessment, and anticipatory guidance. Your child’s Provider will offer age appropriate advice and answer questions you may have.

Well Child Check or preventive medicine services are a type of in-network Evaluation & Management (E/M) service reported with codes 99381-99395. Most health plans provide a 100% benefit (no patient out-of-pocket cost) for the preventive medicine services 99831-99395. The selection of the pediatric-specific codes 99381-99395 is based on the age of the patient and whether the patient is new or established to the practice. There are often other services billed with codes 99381-99395 including but not limited to: screenings, laboratory, and problem-oriented services.

A Problem-Oriented service is typically delivered when there is an acute, chronic condition or a problem found upon examination. You can be billed for a problem-oriented visit alongside a well child check if the problem addressed requires additionally significant work and is medically necessary.

Seven components are considered by health care providers when selection the level ofan E/M service code. Key components used to select a level of E/M include the history, examination, and medical-decision making. Contributory factors are not required for selection of the code, but usually affect the content of the key components performed include counseling, coordination of care and nature of the presenting problem. There is an explicit component of time when time is the controlling factor.

ACP believes that behavioral health is an important part of your child's well-being. We are happy to offer brief, solution-focused behavioral health consultation through the use of psychotherapy to help your with common family and childhood concerns. Psychotherapy is the treatment of mental illness and behavioral disturbances in which the physician or other qualified health care professional, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.

The psychotherapy service codes 90832-90838 include ongoing assessment and adjustment of psychotherapeutic interventions, and may include involvement of informants in the treatment process. Medical symptoms and disorders inform treatment choices of psychotherapeutic interventions, and data from therapeutic communication are used to evaluate the presence, type, and severity of medical symptoms and disorders. For the purposes of billing, the medical and psychotherapeutic components of the service may be separately identified as follows:

1. The type and level of E/M service is selected first based upon the key components of history, examination, and medical decision-making.

2. Time associated with activities used to meet criteria for the E/M service is not included in the time used for reporting the psychotherapy service (ie, time spent on history, examination and medical decision making when used for the E/M service is not psychotherapy time). Time may not be used as the basis of E/M code selection and Prolonged Services may not be reported when psychotherapy with E/M (90833, 90836, 90838) are reported.

3. A separate diagnosis is not required for the reporting of E/M and psychotherapy on the same date of service.

To learn more about Behavioral Health at ACP click here.

The following codes are used to report the services provided to newborns (birth through the first 28 days) in several different settings. Use of the routine newborn codes is limited to the initial care of the newborn in the first days after birth prior to home discharge.

For E/M services provided to newborns who are other than routine, see codes for hospital inpatient services (99221-99233) and neonatal intensive and critical care services (99466-99469, 99477-99480). When routine newborn services are provided by the same individual on the same date that the newborn later becomes ill and receives additional intensive or critical care services, report the appropriate E/M code with modifier 25 for these services in addition to the normal newborn code.

Evaluation and Management (E/M) services for the newborn include maternal and/or fetal and newborn history, newborn physical examination(s), ordering of diagnostic tests and treatments, meetings with the family, and documentation in the medical record. When delivery room attendance services (99464) or delivery room resuscitation services (99465) are required, report these in addition to routine newborn services Evaluation and Management codes.

Standardized screening instruments are used for screening and assessment purposed reported by codes 96110 and 96127. Health risk assessment that are patient focused (96160) are differentiated from those such as maternal depression screening that are caregiver focused (96161) for the benefit of the patient(ie validated tests that are administered and scored in a consistent and "standard" manner consistent with their validation). Screenings include Ages & Stages Questionnaire, Edinburgh Postpartum Depression Screening, Patient Health Questionniare, Vanderbilt Assessments, and Asthma Control Tests, among others.

ACP follows the AAP/Bright Futures recommendations for preventive pediatric health care in regards to age-appropriate screening services. Some test performed in the office are typically classified as a screening laboratory test and may need further confirmatory testing. Providers will use clinical judgement for laboratory testing for services outside of the preventive scope. Laboratory testing includes Hemoglobin, Lead, Urinalysis, Strep Screen and rapid COVID-19 testing, among others.