Pediatric Coding Alert

Find out if your coding knowledge is up to date.

Once you’ve answered the quiz questions on page 91, compare your answers with the ones provided below: 

Answer 1: On Jan. 1, 2019, CPT^® deleted 99090 (Analysis of clinical data stored in computers (eg, ECGs, blood pressures, hematologic data)) and replaced it with three new codes:

• 99453 (Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment)
• 99454 (Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days)
• 99457 (Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month).

The new codes allow you to document setting up the data-gathering device and teaching the patient how to use it (99453), suppling the device for daily recording or programmed alert transmissions (99454), and monitoring the data gathered and communicating any information and care plan revisions to the patient based on a provider or other qualified healthcare professional’s interpretation of the device’s data (99457).

At the time, we noted that while the codes represent “an interesting step toward including IT-related monitoring of a patient’s chronic conditions, the required documentation for these codes, such as the number of reports per month, signatures, which staff will review the results, and so on seems unclear,” according to Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California.

Answer 2: Beginning Jan. 1, 2019, you and your provider no longer had to:

• Document medical necessity for a home visit instead of an office visit;
• Re-record elements in the medical record if the physician reviewed the previous information and updated it as needed or noted pertinent items that have not changed;
• Re-record the patient’s chief complaint and history, and just simply indicate in the medical record that the information has been reviewed and verified, if staff or the patient have already entered the information; or
• Re-record information included in medical records by residents or other members of the medical team.

The changes, which affected both Medicare and CPT^® guidelines, are part of the Centers for Medicare and Medicaid Services’ (CMS’) ongoing revision of E/M services. Looking ahead, this means you will need to stay informed “of the upcoming changes to both CPT^® and Medicare rules and then follow additional announcements from both the AMA and Medicare very closely,” according to Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

Answer 3: CPT^® will delete online E/M service codes 99444 (Online evaluation and management service provided by a physician or other qualified health care professional …) and 98969 (Online assessment and management service provided by a qualified nonphysician health care professional …) effective Jan. 1, 2020.

Next year, in their place, you will be able to use the following:

• 99421 (Online digital evaluation and management service, … 5-10 minutes)
• 99422 (… 11-20 minutes)
• 99423 (… 21 or more minutes)
• 98970 (Qualified nonphysician health care profes­sional online digital evaluation and management service … 5-10 minutes)
• 98971 (… 11-20 minutes)
• 98972 (… 21 or more minutes).

Guidelines for the services note that they must be provided to an established patient (or guardian) and that they must not result from an E/M visit that occurred in the last seven days or result in a subsequent E/M visit over the next seven days. In these cases, the virtual E/M is not separately reported and is incorporated into the related E/M visit.

In addition, 98970-98972 must be provided by a qualified nonphysician healthcare professional (QNHP), while 99421-99423 can only be used for services furnished by a qualified healthcare professional (QHP).