Adolescent confidentiality has come up more in the news lately, largely because of advances like the HPV vaccine, which can be administered as young as 11 or 12 years old. Because of this, many providers, obstetrician-gynecologists especially, should take time to review their use of pediatric medical billing and coding services to ensure they’re addressing the privacy of their younger patients correctly [1]. 

This is especially challenging at the billing level. Even if a provider is dedicated to adolescent confidentiality, their billing practices can involve creating highly detailed statements, especially explanation of benefits (EOBs) that list lab tests, prescriptions, or diagnoses that break confidentiality. For providers, this means they will need to address their pediatric medical billing and coding services to review for confidentiality. Some will need to consider reviewing options with pediatric medical billing companies for support. 

In some cases, some modifiers that are used with preventative services provided under the Patient Protection and Affordable Care Act can be used to generate non-itemized EOB statements. These modifiers also signal to third-party payers that a claim needs special treatment, since many plans also send an EOB that details information like services provided, labs, and office visit information. Other options include having a practice of referrals to alternate health care centers if billing disclosure is a risk and confidential billing is still a challenge.

Addressing confidentiality in your pediatric medical billing and coding services can require much more than simply using a new modifier or referral. You will need to train and prepare your staff on questions and how to address the issue with sensitivity. This can include comfort with topics and issues around adolescent sexuality, informing them about confidentiality issues, at both the national, state and local levels, and using “code words” to support the safety and security of adolescent patients. 

Ultimately, if this is something your staff isn’t comfortable with, it’s worth reaching out to pediatric medical billing companies.

[1] American College of Obstetricians and Gynecologists, “Confidentiality in Adolescent Health Care,” 26 March 2020. Available:


Hemant Apte, Chief Executive Officer in

Hemant Apte, Founder & Chief Executive Officer of 3Gen Consulting, is a seasoned executive leader with deep domain expertise in US healthcare management practices. He founded 3Gen Consulting in 2006 and has been instrumental in offering thought leadership to his clients and providing services and solutions that are unique in the market.

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