Insurance/HSA or FSA Reimbursement

** ICD-10 CODES MANDATORY IN OCTOBER 2015. First listed CODES BELOW ARE ICD-9, USE THESE CODES unless specified by insurer. Codes in parenthesis are ICD-10. This page is a work in progress as codes transition, so PLEASE CONTACT ME WITH ANY QUESTIONS AND I’LL HELP YOU. [email protected] **

Please use this page to submit a readable copy of my receipt for possible reimbursement from your insurance company. Please note, each plan is different with varying levels of benefits. The House Call visit may not be fully or even partially reimbursed.

You may also submit my receipt to your Federal or Health Savings Account for consideration. Codes may or may not be needed, put them on to be safe!

Write the appropriate code by each diagnosis (“Diagnosis Code”) on the receipt, as well as by the visit charge (new or established patient) and by any treatment charge (pulse ox, strep test, nebulizer treatment) (“Procedure Code”). If you do not find your diagnosis on the list, please email me ([email protected]). Make a readable copy of the receipt and send that, along with a note asking for consideration for reimbursement, to your insurance carrier. Some carriers may ask you to fill out their form. If so, use this information to complete the form. My tax ID number and license number are on the top of the receipt if needed. If not, please list it in by my name: #27-0985640.
Note: Medications are not reimbursable. New patient means the first time I come to your house, established patient means subsequent visits.

Abdominal Pain (R10.84)
Abrasion: (T14.8)
Abscess: (L02)
AGE: 558.3 (A090)
Allergic Conjunctivitis: (H10.45)
Allergic Rhinitis: (J30.1)
Asthma (stable): 493.0 (J45.20)
Asthma Exacerbation: 493.22 (J45.901)
Balanitis: (N48.1)
Bronchiolitis: 466.11 (J21.9)
Bronchitis: 466.0 (J40)
Bronchospasm: 519.11 (J98.01)
Bullous Impetigo: (L01.03)
Candidial Diaper Rash: (B37.2)
Cat Bite: (W55.01)
Cellulitis: (L03)
Cerumen Impaction: 380.4 (H61.23)
Chronic Sinusitis: J32.9
Conjunctivitis: 372.01 (H10.013)
Contact Dermatitis: (L25)
Costochondritis: (R07.9)
Coxsackie: 079.2 (B97.11)
Croup 464.4 (J05.0)
Dermatitis, Unspecified (L30.9)
Diaper Dermatitis: (L22)
Diarrhea: (R19.7)
Dog Bite: (W54)
Dry Skin Dermatitis (L85.3)
Eczema: (L30.9)
Epistaxis: (R04.0)
Fall: (W19)
Fever: 780.6 (R50.9)
Fifth Disease: (B08.3)
Folliculitis: (L66.2)
Foreign Body (Ear): (T16.9XXA)
Foreign Body (Nose): (S00.35XS)
Foreign Body (Splinter) of foot: infected: (S91.3)
Foreign Body (Splinter) of foot without infection: (S90.859A)
Foreign Body (Splinter) of hand without infection: 914.6 ( S60.559A)
Foreign Body (Splinter, foot) Removal: (PCS.0HCMXZZ)
Foreign Body Removal (Ear) (“Procedure Code”): (PCS.09C0XZZ)
Foreign Body Removal (Nose) (“Procedure Code”): (PCS.09CKXZZ)
Fussy Baby: 780.91 (R68.12)
Gastroenteritis: (K52.9)
Head Injury: 959.01 (S09.90XA)
Heart Murmur: (R01.1)
Herpangina: 074.0 (B08.5)
Idiopathic Urticaria (L50.1)
Impetigo: (L01.00)
Incision and Drainage, Simple: (10060)
Human Bite: (E928.3)
Influenza: (J09.X2)
Injury of face or neck (nose): 959.09 (S09.93XA)
Injury of hand (not finger): 959.4 (S60.929A)
Insect Bites (including tick): 919.4 (T07)
Jaundice: 774.6 (P58.9)
Keratosis Pilaris: 757.39 (L85.8)
Laceration repair, initial encounter: T81.33XA
Laceration without foreign body of scalp, initial encounter: S01.01XA
Lice: B85.0
Molluscum Contagiosum: 078.0 (B08.1)
Nasolacrimal Duct Obstruction 375.56 (H04.539)
Nebulizer Treatment (“Procedure Code”): 94640 #1 / 94640-76: #2 & #3
Nevus: 448.1 (I78.1)
Newborn Feeding Problem: 779.3 (P92.9)
Nursemaid’s Elbow: 832.2 (S53.033S)
OE: H60.3
OM (L or R): 382.9 (H66.90)
Otalgia: 388.70 (H92.09)
Paronychia: 681.02/Cellulitis of unspecified finger: L03.019
PCN Allergy: V14.01
Perforated TM: 384.2 (H72.90)
Petechiae: 782.7 (R23.3)
Pharyngitis: 462 (J02.9)
Plantar Wart: 078.12 (B07.0)
Pneumonia: 482 (J17)
Pulse Ox (“Procedure Code”): 94760
Purulent OM: 382.4 (H66.40)
R/O TB (for daycare or school entry): V74.1
Rapid Strep Test (“Procedure Code”): 87880QW
Reflux: 530.81 (K21.0)
Respiratory Distress: 786.09 (J80)
Roseola: 058.10 (B08.21)
Scarlet Fever: A38.9
Seborrhea: 706.3 (L21.9)
Seborrhoeic Dermatitis: 690.10 (L21.9)
Sinusitis: J01.00
SOM (L, R or B): H65.00
Strep: Peri-Anal: B95.5
Strep Pharyngitis: 034.0 (J02.0)
Suture Removal (Procedure Code”): V58.32
Teething: 526.7 (K00.7)
Tinea Corporis: 110.5 (B35.4)
Unspecified injury of face: S09.93XA
URI: 465.9 (J06.9)
Urticaria: 708 (L50.0)
Viral Syndrome: 79.99 (B34.9)
Visit Charge/House Call Charge (“Procedure Code”): 99343-new pt/ 99348-est. pt/ 99344-new pt for
Vomiting: 787.03 (R11.1)
Weight Loss: 783.21 (R63.4)
Well Child Exam v20.2 (Z00.129)
Wheezing/asthma visit (est. pt=99350)
Wheezing: 786.07 (R06.2)