A Pediatric E&M Tidbit

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.