Primary Care Lunch and Learn: Coding and the business of pediatrics

Objectives (Educational Content) :

1. Develop and understanding of the history of coding for billing medical services.

2. Recognize financial challenge in selecting pediatrics as a career choice.

3. Review fundamentals of CPT coding as it pertains to primary care pediatrics.

Target Audience:

General pediatricians, family physicians, nurse practitioners, physician assistants, social workers, psychologists, and nurses.

Identified Gap:

Many pediatric clinicians and practice leaders do not consistently apply current CPT® Evaluation & Management (E/M) guidelines across outpatient and inpatient settings, resulting in under-coding, over-coding, documentation deficiencies, claim denials, and lost revenue. This reflects knowledge and competence gaps stemming from significant E/M revisions in 2021 (office/outpatient) and 2023 (other E/M settings), which require selection based on medical decision making or total time and updated documentation expectations. Optimal practice would include accurate code selection and documentation aligned with the latest CPT guidance, leading to appropriate reimbursement and sustainable pediatric practice operations.

Estimated Time to Complete the Educational Activity:

1 hour(s)

Expiration Date for CE/CME Credit:

01-07-2027

Method of Participation in the Learning Process:

The learner will view the presentation, successfully complete a post-test and complete an activity evaluation.

Evaluation Methods:

All learners must successfully complete a post-test, as well as an activity evaluation, to claim CE/CME credit.

Disclosure:

The following presenter has indicated that no financial relationship with an ineligible company: David Cahill, MD The following planning committee member has indicated that a financial relationship with an ineligible company: All relationships have been mitigated. The remaining planning committee/CME committee members have indicated that they have no financial relationships with any ineligible companies.

Accreditation Statement:

Children’s Hospital Medical Center of Akron is accredited by the Ohio State Medical Association to provide continuing medical education for physicians.

CHMCA designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit TM.  Physicians should only claim the credit commensurate with the extent of their participation in the activity.

Bibliography:

1. American Medical Association. (2024). CPT 2025: Current Procedural Terminology. American Medical Association

2. American Academy of Pediatrics. Coding for Pediatrics 2025. Itasca, Il: American Academy of Pediatrics; 2024

3. American Academy of Pediatrics. Pediatric Coding Newsletter Itasca, Il: American Academy of Pediatrics; 2025