---
title: A Pediatric E&M Tidbit
description: A Pediatric E&M Tidbit
---

# A Pediatric E&M Tidbit

February 18, 2008

[coding](https://chipsblog.pcc.com/tag/coding)

While I'm mentioning samples from my seminar collection, here's something I just received from PCC's coding Igor (ette). She was at a local E&M coding conference and reported this tidbit:

> Comprehensive exam is defensible for Medical Necessity simply by virtue of being a peds exam (developmental component not present for other specialties), by exploration of mechanism of injury, systemic/chronic disease involvement.

A much more eloquent (and concise) way of putting something I've been trying to say for years.  When I discuss pediatric E&M distribution, I often find myself fighting the perception among pediatricians that pediatric visits aren't complex - it's easy, kids' stuff.  "Adult medicine, especially with all those chronic conditions and crazy medications...now *that's *complex."  I don't buy it.  Why?

- Nearly every pediatric visit has a layer of communication complexity simply not found in other specialties.  Many of your patients can't even talk!  Usually, though, you have to translate something a parent says and balance that against what you are seeing...and balance *that* against what the patient tells you.  That's easy for pediatricians, but not for someone who hasn't been trained and does it every day.
- You have developmental issues.  Every well visit is an acute visit waiting to happen.  Every acute visit is a chronic diagnosis in disguise.  The example I always used to give was a simple sore throat - don't you always check a dozen other developmental issues while you're at it?  I thought the language above made and excellent point.

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