Pediatric Coding Alert

Find out when and how to break payment bundles for I&D, continuous inhalation treatment, and home apnea monitoring with these insider secrets.

If your pediatrician performs an incision and drainage (I&D) and then applies an Unna boot, you may have to reduce your coding from two procedures to one. No bundling issues now exist on these procedures, says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop & Associates.

But that's going to change for payers that follow Correct Coding Initiative (CCI) edits. Starting April 1, new version 14.1 puts an end to also coding the strapping (29580, Strapping; Unna boot). The CCI edits bundle Unna boot strapping code 29580 into five I&D codes and one debridement code including:

Exception: You may, however, report an Unna boot strapping with the above codes when the procedures occur on separate sites. "The edits permit you to use modifier 59 (Distinct procedural service) to break the bundle under extenuating circumstances, such as different anatomical sites, supported with documentation," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

"An Unna boot is a dressing and wrap combination that is applied from the foot to the knee," according to the Bishop, Calif.-based Northern Inyo Hospital's Unna Boot (Pediatric) Discharge Instructions.

The boot's gauze contains a special medication to help heal burns or skin sores and protect new skin. Expect children with an Unna boot to visit the doctor to have the Unna boot changed every-one-to-three-days for a white bandage boot and weekly for the pink bandage. Code these services with 29580, which has zero global days.

Beware of one new bundle when coding inhalation treatments. You should not report an individual inhalation treatment, such as with a nebulizer, in addition to continuous inhalation treatment. CCI makes inhalation treatment code 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) a component of the more extensive procedure 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour).

Warning: The edits do not allow you to override the bundle under any circumstances. Choose the correct code based on time following these guidelines:

• Use 94640 for intermittent inhalation treatment.

• Restrict 94644 to only procedures lasting 60 minutes, according to Medical Learning Inc.'s respiratory compliance experts.

How many medicine codes should you report if your pediatrician interprets results from an electrocardiogram (ECG) and home apnea monitoring recording? The answer is one, CCI 14.1 says. Pediatric home apnea monitoring (94774-94777) includes a related ECG (93000-93010).

Bundles also apply to telephonic transmission (93012-93014), ECG rhythm strips (93040-93042), pediatric pneumogram (94772) and sleep testing (95805).

The edits bring CMS in line with CPT. CPT Changes 2007: An Insider's View states, "94774 includes attaching the monitor, downloading the data, reviewing and inter-preting the data by a physician, and preparation of the report," says Jill M. Young, CPC-ED, CPC-IM, president of Young Medical Consulting LLC in East Lansing, Mich. "Any 'downloading of data' whether on-site or an electronic transmission would be included."

Because the monitors relay ECG information, the monitoring includes the ECG component -- a fact the CPT Manual asserts. "Parenthetical notes after the 94774-94777 section address not billing for ECG and an apnea recording device," Young says.

The edits have a 1 indicator, meaning if the physician orders the monitoring and the cardiovascular/pulmonary testing at different sessions or to evaluate different body regions, you could report the test code appended with modifier 59 (Distinct procedural service).