🩺 Pediatrics Coding Cheat Sheet
(Quick Reference for Pediatric Medical Coders)
🧩 1. Common Pediatric CPT Codes
A. Evaluation & Management (E/M) – Office Visits
Type CPT Code Description
New Patient 99202–99205 Initial office visits (based on time or MDM)
Established Patient 99212–99215 Follow-up visits (based on time or MDM)
Preventive / Well-Child Visits 99381–99385 New patient preventive visits (age-based)
99391–99395 Established patient preventive visits (age-based)
🍼 Example:
99381 → New patient, under 1 year
99392 → Established patient, ages 1–4
99393 → Established patient, ages 5–11
B. Hospital and Emergency Services
Service CPT Code
Initial hospital care 99221–99223
Subsequent hospital care 99231–99233
Hospital discharge 99238–99239
Neonatal intensive care 99468–99469
Pediatric critical care 99291–99292
Emergency department visit 99281–99285
C. Common Pediatric Procedures
Procedure CPT Code
Newborn care (initial) 99460
Newborn care (subsequent) 99462
Developmental screening 96110
Behavioral health screening 96127
Vision screening 99173
Hearing screening 92551
Pulse oximetry (screening) 94760
Capillary blood draw 36416
Immunization administration (first vaccine) 90460
Immunization administration (each additional vaccine) 90461
Nebulizer treatment 94640
Rapid strep test 87880
Rapid flu test 87804
Urinalysis (dipstick, automated) 81003
💉 2. Common Vaccine Codes (CPT)
Vaccine CPT Code
DTaP 90700
Hepatitis B 90744
Hib (Haemophilus influenzae type B) 90648
IPV (Polio) 90713
MMR (Measles, Mumps, Rubella) 90707
Varicella (Chickenpox) 90716
Influenza (Flu shot) 90686 (quadrivalent, preservative-free)
Pneumococcal conjugate (PCV20) 90677
Rotavirus (oral) 90680
HPV (Human Papillomavirus, 9-valent) 90651
COVID-19 (pediatric dose) 91321–91323 (based on manufacturer/age)
🩹 Tip:
Always report both the vaccine code (product) and the administration code (90460/90461).
🧠 3. Common ICD-10-CM Codes in Pediatrics
A. Well Visits and Preventive Care
Condition ICD-10 Code Description
Routine child health exam (no abnormal findings) Z00.129 Well-child visit, normal
Routine child health exam (with abnormal findings) Z00.121 Well-child visit, abnormal
Immunization encounter Z23 Encounter for immunization
B. Common Pediatric Illnesses
Condition ICD-10 Code
Acute otitis media (ear infection) H66.90
Streptococcal sore throat J02.0
Acute upper respiratory infection J06.9
Bronchitis J20.9
Influenza (flu) J10.1
Asthma, unspecified J45.909
Gastroenteritis (stomach flu) A09
Fever, unspecified R50.9
Rash, unspecified R21
Viral infection, unspecified B34.9
C. Developmental & Behavioral
Condition ICD-10 Code
ADHD, combined type F90.2
Autism spectrum disorder F84.0
Speech delay F80.9
Learning disorder F81.9
Anxiety disorder F41.9
Depression, unspecified F32.A
D. Injuries and Accidents
Condition ICD-10 Code
Fall from playground equipment W09.8XXA
Superficial head injury S00.90XA
Forearm fracture S52.90XA
Laceration without foreign body S01.81XA
⚠️ Always use 7th character (e.g., “A” for initial encounter) when coding injuries.
🧾 4. Modifiers Commonly Used in Pediatrics
Modifier Description When to Use
-25 Significant, separately identifiable E/M service on same day as procedure Sick visit + vaccine
-59 Distinct procedural service Two procedures at different sites
-52 Reduced services Shortened or incomplete procedure
-76 Repeat procedure by same provider Repeat lab or test same day
-77 Repeat procedure by different provider Another provider repeats test
-59 / -XS / -XU Specific procedural distinctions For NCCI edits (Medicare)
🩸 5. Growth & Development Screenings
Test CPT Code
Developmental screening (ASQ, M-CHAT) 96110
Behavioral/emotional assessment 96127
Depression screening (PHQ-9) 96127
Lead testing (capillary) 83655
Hemoglobin test 85018
🧒 6. Preventive Counseling and Risk Assessments
Topic ICD-10 Code
Dietary counseling Z71.3
Exercise counseling Z71.82
Tobacco use counseling (adolescent) Z71.6
Counseling for parent of child Z71.89
🧩 7. Tips for Accurate Pediatric Coding
✅ Link ICD-10 codes to the correct CPT code (e.g., Z23 → 90460 + vaccine CPT).
✅ Always document time for prolonged visits or counseling.
✅ Include growth, development, and immunization status in preventive visits.
✅ Use age-appropriate E/M codes for preventive services (99381–99395).
✅ Append modifier -25 when performing both a preventive and a sick visit on the same day.
✅ Always check payer-specific immunization requirements (some vaccines need specific administration codes).
🏁 Summary Table
Category Common Codes
E/M Office Visits 99202–99215
Preventive Visits 99381–99395
Vaccines 90686 (flu), 90716 (varicella), 90460 (admin)
Procedures 96110 (developmental), 94760 (pulse ox), 36416 (blood draw)
ICD-10 Well Visit Z00.129
ICD-10 Immunization Z23
Modifiers -25, -59, -76
Screenings 96127 (behavioral), 99173 (vision), 92551 (hearing)
🧸 Final Thought
Pediatric coding requires attention to age-based preventive services, growth and development screenings, and immunizations.
Always ensure:
Documentation supports services billed
CPT and ICD-10 codes match
Modifiers are used correctly when combining services
Accurate coding helps ensure children receive comprehensive care while your practice receives proper reimbursement.
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