Pediatric Coding Alert

Sheryl Cilento, office manager for Liberty Child and Adolescent Health Services, an 11-pediatrician practice in Jersey City, NJ, wants to know how to use CPT Codes to manage babies and children who are being cared for at home. Often a newborn is discharged and there is a visiting nurse ordered by the home health agency, says Cilento. Or a child might have gastroenteritis and needs diet and medication to be supervised, or sometimes there is a case of juvenile diabetes. The pediatrician always has to be involved. There is an inordinate amount of paperwork -- orders to fill, reorder forms, often on a monthly basis. This is a busy urban practice with many children on managed Medicaid. Is there any way that Cilentos practice can bill for the time it spends overseeing the care of patients who are being treated at home?

The answer is a resounding yes. There are care plan oversight codes, as of CPT 98, for patients under the care of home health agencies, hospice patients, and nursing facility patients. All of these codes must be used only when the pediatrician is supervising care others are providing to the child, not when the pediatrician does face-to-face care, as in home visits. (Note: For more information on home-visit coding see cover article in March 1998 issue of PCA).

There are two basic aspects of these oversight codes which are new for 1998. One is that they are broken down into two units: 15 to 29 minutes and 30 minutes and above. In CPT 97, the smallest unit was 30 minutes. This means that you can now bill for as little as 15 minutes a month spent overseeing a case. That 15 minutes can be cumulative, so that you may spend 5 minutes one day and 10 minutes another day on the case. The key is that you must keep track of your time over a month, and file one bill a month for your care plan oversight services.

Hospice and Nursing Facility Care Plans

The other new aspect of these codes is the addition of hospice and nursing facility care plans. While such cases are not common in pediatrics, they are, unfortunately, getting more frequent, says Peter Rappo, MD, FAAP, chairperson of the AAP Committee on Ambulatory and Practice Medicine. Children with muscular dystrophies are living longer, and need to be in nursing facilities, says Rappo, who practices in Brockton, MA. And we do have kids who are terminally ill. Rappo notes that AIDS is increasing among children. Also, pediatric patients with terminal malignancies and renal conditions are often in hospices.

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