Pediatric Coding Tips: How to Maximize Payment for Everyday Visits

I love that being a pediatrician means I’m always learning — about medicine, child development, new medications. But I have to admit, learning about coding doesn’t give me the same thrill as reading about the latest treatment for RSV.

Still, coding is foundational. It’s how we make sure our time, skill, and care are recognized and reimbursed. So I was grateful to sit down again with pediatrician and coding expert extraordinaire Dr. Richard Lander for some Peds Reviews and Perspectives segments on this vital skill.

In Part 1 of our conversation, we covered the basics: documentation, medical decision-making, and time-based billing (for the cliff notes version, check out our overview). In Part 2, we dug into practical tips and often-missed billing opportunities that can make a real difference in outpatient pediatrics.

Dr. Lander’s advice? Don’t undercode. If you’re doing the work, make sure you’re getting credit for it.

Capture Every Detail in Well-Child Visit Coding

Well checks may seem straightforward when it comes to coding, but they’re often packed with billable services. Dr. Lander encourages pediatricians and primary care clinicians to think beyond the age-based E/M code. Don’t forget to include codes for:

• Vaccinations: Remember that there are different codes for the specific vaccine, administration, and counseling.

• Procedures: Checking a hemoglobin? Applying fluoride varnish? Lead check? These are all billable pediatric codes.

• Screeners: When you follow the AAP and Bright Futures recommended screening schedule, don’t forget to add the code for each screener. Maternal depression, M-CHAT, developmental screen, Depression and suicide risk — these all count!
            - Note: If you use both a developmental screen and an Autism screen at the same visit (for example, an ASQ and an M-CHAT), you can bill the screening code 2x.
            - An often underused code is screening for social determinants of health. The AAP recommends incorporating a social needs screening tool along with a referral system to help make sure we’re addressing the needs of our patients and families.

• Counseling: That deep dive into nutrition or physical activity? There are separate counseling codes for each of these important services. Some payors bundle them together with a well visit, but others reimburse them as separate additional services. The CPT codes for counseling are based on time (99401-99404). The diagnosis code, or ICD-10, will depend on the reason for the counseling. For example:

            - Z71.3: Dietary counseling and surveillance

            - Z71.82: Exercise counseling

            - Z71.84: Encounter for health counseling related to travel

   

• Coding for Vaccine discussions: This deserves its own highlight. As of January 1, 2026, you can now code for vaccine discussions even when vaccines are not administered.

• Use a 25 modifier plus either problem-based or time-based billing in this situation.
  

Use Modifier 25 Correctly for Combined Well and Sick Visits

This modifier is your best friend when a separate, significant issue is addressed during a preventive visit. Just remember: your documentation must show that the additional work was beyond what’s typically included in a well-child exam.

Sick Visit Coding in Pediatrics: Beyond the 99213

Acute visits are another area where clinicians may be leaving money on the table. Here are some add-on codes that might apply:

• 99058: The physician interrupted his or her care of another patient to deal with an emergency or perceived emergency.

• 99050: Medical services provided outside of a practice's regular office hours.

• 99051: Medical services provided during regularly scheduled evening, weekend, or holiday office hours.

• G2211: A visit complexity add-on code for ongoing care within a pediatric or family medicine practice.

Get Paid for Procedures You Already Perform

Many pediatricians do minor procedures regularly but forget to bill for them. It might seem like “too much effort” to look up the code. Or maybe you’re worried the insurance won’t reimburse. But remember, you’re doing the work and providing the service. Ultimately, coding and billing correctly provide important service to your patient and your practice. Make sure your EHR is set up so that you have easy access to common procedure codes like:

• 69210: Cerumen removal (using instrumentation)

• 69209: Cerumen removal (using irrigation/lavage)

• 17250: Cauterization of umbilical granuloma

• 24640: Nursemaid’s elbow reduction

Telephone Visit Billing Codes: Make That Phone Call Count

There are three different service levels for telephone calls, and the only difference is the length of the call.

• 99441: 5-10 minute discussion

• 99442: 11-20 minute discussion

• 99443: 21-30 minute discussion

But there’s an important caveat: You cannot bill for the telephone call if it leads to an encounter or procedure within the next 24 hours, nor if it is related to an encounter that occurred within the previous 7 days.

Are You Coding for Patient Email or Portal Messages?

I’ll be honest, this one seems like the wild west to me. I think most of us pediatricians don’t routinely bill for email or portal messages. But electronic communication is on the rise, and more and more insurance companies are starting to reimburse. Here’s your cheatsheet for digital evaluation and management services:

• 99421: 5-10 minutes discussion

• 99422: 11-20 minutes discussion

• 99423: 21-30 minutes discussion

The number of minutes reflects the total time spent in a 7-day period. So if you’re in a back-and-forth email exchange, those brief responses can add up! Note that these codes are only for established patients, and only for “evaluative communication,” in which you’re evaluating an issue.

Consider Time-Based Coding and G2211 Tips

Time-based coding can be especially helpful for complex visits involving significant counseling, care coordination, or extensive documentation.

And if you’re not adding on the G2211 add-on code, you should start. It’s designed for primary care clinicians managing ongoing care, which includes most of our sick visits if you work in private practice or a community clinic.

Avoiding Denials: Documentation and Appeal Strategies That Work

If you're coding accurately and still get denied, don’t give up. Appeal. And use tools like the AAP Coding Hotline or the AAP Hassle Factor Form to flag persistent payer issues. Your documentation is your defense; make sure it’s thorough, clear, and supports your code selection.

Stay Updated on Pediatric Coding

Pediatric coding rules are always evolving. Keep your EHR and trusted resources up to date so you’re aware of the latest changes. Even the codes we’ve shared here may shift over time, so periodically review updates and your commonly used codes to avoid surprises.

Make Your Work Count

Pediatric billing and coding isn’t just administrative busywork. It’s how we ensure our time, training, and care are respected and reimbursed. Whether it’s a well-child visit, a sick visit, or a quick portal message that turns into 15 minutes of clinical guidance, your work deserves to be valued.

For more practical pediatric coding tips, revisit our earlier blog or check out our Peds Reviews and Perspectives episode, "Coding Mastery: What Every Pediatrician Needs to Know."