Pediatric Coding Alert

Tally telephone calls, lab review, care plan revision minutes

If you think you perform care plan oversight services, but you're not sure how to use the 993xx series, these fundamentals will get you started.

1. Count These Care Services as 99374-99380

The 993xx series allows pediatricians to bill for non-face-to-face coordination of care for children with special needs. You may report care plan oversight (CPO) codes (99374-99380, Physician supervision ...) when the patient is not present for the following physician services:

• development and/or revision of care plans for complex and multidisciplinary care modalities

• review of subsequent patient status reports

• review of related lab and other studies

• telephone calls and Internet communication for assessment or care decisions with healthcare professionals, family, legal guardian and/or key care giver(s)

• integration of new information into the medical treatment plan and/or adjustment of medical therapy.

2. Identify 'Agency' to Determine Code Set

Although CPT 2006 will expand CPO codes facility supervision entities, you may now only report these services when the patient meets one of three conditions:

• is under the care of a home health agency--99374 or 99375.

• is on hospice--99377 or 99378.

• is a nursing facility patient--99379 or CPT 99380 .

3. Total Monthly Minutes for Exact Code

You must bill CPO codes based on 30-minute segments. When you perform and document 15-29 minutes of CPO services within a calendar month, use the first code in each of the above sets (99374, 99377, 99379). For 30 minutes or more of services within a calendar month, such as October, report the second set of codes (99375, 99378 or 99380).