Pediatric Coding Alert

Outlying hospitals: Make sure you add 94610 to your encounter sheet

Thanks to CPT 2007, you'll soon have two physician- specific codes to describe the initial work and periodic interpretation involved in pediatric home apnea monitoring.

The pulmonary subsection of CPT's medicine section gets a major overhaul with a split into two sub-subsections for "ventilator management" and "other procedures."

New pulmonary codes will be added for home apnea monitoring, ventilator management and surfactant administration. Here are the major pediatric-impacting changes in the pulmonary subsection that you can expect, which are discussed in-depth on the corresponding pages noted below (changes 1-3 reflect the circumcision changes that appear on pages 90-91):

Change 4: Although CPT 2007 will create four home apnea monitoring codes, only two of these codes apply to physicians, says Jill M. Young, CPC-EDS, president of Young Medical Consulting LLC in East Lansing, Mich. "Home health agencies (HHAs) will use the other two codes, which involve no physician work."

New code for initial set-up: When you first decide that a patient requires home monitoring, assign 94774. The code encompasses five services. According to CPT Changes: An Insider's View 2007, the physician:

• orders home monitoring
• chooses the monitor limits
• arranges for a home care provider to meet with the parents
• interprets data supplied by the HHA monthly or after any significant home apnea episode
• prepares a report.

New code for periodic review: From the HHA, the pediatrician will periodically receive downloaded information in hard copy or CD form, which he interprets and issues a report on. The report includes recommendations on continuing or discontinuing the monitoring. Code 94777 describes the "physician review, interpretation and preparation of report only."

Keep in mind: Don't interpret 94774 (Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; includes monitor attachment, download of data, physician review, interpretation, and preparation of a report) and 94777 to mean the pediatrician has to relay the information contained in the report. The physician could "send the report back to the primary-care provider for him to discuss with the patient," Young says. Alternatively, the interpreting physician (who is taking care of the patient) could speak with the family.

Follow 2 Rules When Coding Vent Mgt CPO

Change 5: CPT 2007 will also provide you with a way to code home ventilator management.

New monthly CPO code: For each month of 30 minutes or more of home ventilator management care plan oversight (CPO), you will be able to report 94005, which includes:

• review of status
• review of laboratories and other studies
• revision of orders and respiratory care plan (as appropriate).

When using 94005 (Home ventilator management care plan oversight of a patient [patient not present] in home, domiciliary or rest home [e.g., assisted living] requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan [as appropriate], within a calendar month, 30 minutes or more), remember these rules:

Rule 1: This service cannot be reported in conjunction with other home (99339-99340) or home health agency, hospice or nursing facility (99374-99378) CPO services, states the parenthetical instruction following 94005 in the CPT 2007 manual.

Rule 2: You can still use 94005 when another physician concurrently provides CPO during the same period.

Base Daily Vent Mgt Code on POS, Day

For ventilator management in the hospital or nursing facility, you should use new codes 94002-94004, which replace deleted codes 94656 and 94657. These services are now site-specific.

Change 6: Choose the appropriate daily ventilation management code, which describes "ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing," based on the place of service (POS) and performance day:"

Caveat: Do not report ventilation management codes 94002-94004 in addition to critical care services (99289-99299). When you provide both services, code only for the critical care service.

Report 94610 for Pretransfer Surfactant

You will soon have a code for surfactant administration performed in a delivery room or outlying hospital prior to patient transfer.

Change 7: When a local care team provides the initial installation of surfactant prior to the transport of a neonate to the regional nursery, assign 94610 (Intrapulmonary surfactant administration by a physician through endotracheal tube). "Surfactant can be given in the hospital and delivery room and on transport," says Richard A. Molteni, MD, FAAP, a neonatologist and medical director at Children's Hospital and Regional Medical Center in Seattle.

Warning: CPT 2007 indicates that you should not report 94610 in addition to pediatric and neonatal critical care services (99293-99296). "Code 94610 can be added to transport and noncritical care services reported on the same day," Molteni says.