Pediatric Coding Alert

Plus: New otoacoustic testing codes could benefit your hearing-impaired patients.

When CPT® 2011 debuted the subsequent observation care codes 99224-99226, many coders were left scratching their heads at the fact that those new codes featured typical times associated with them, even though the initial observation care codes 99218-99220 didn't have typical times. The new edition of your CPT® manual, which takes effect on Jan. 1, will remedy that problem, with the addition of the following typical time guidelines:

• 99218 -- ...Physicians typically spend 30 minutes at the bedside and on the patient's hospital floor or unit
• 99219 -- ...Physicians typically spend 50 minutes at the bedside and on the patient's hospital floor or unit
• 99220 -- ...Physicians typically spend 70 minutes at the bedside and on the patient's hospital floor or unit

The addition of typical times will open the door for coding based on time, consistent with the other codes in the observation care series.

"There are only two ways that you can use time as a basis for selecting an E/M code," says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. "If counseling/coordination of care takes up 50 percent or more of the visit, and if the code has a typical time associated with it. So by these codes now having a time reference, it sounds like we may have a way to reference time used if counseling or coordination of care takes up at least 50 percent of a visit. In addition, this could open the door to collecting for prolonged service times if the time the doctor spends exceeds 30 minutes more than the allotted time, and the visit notes are documented as such," Cobuzzi adds.

The observation care codes are outpatient site of service, but time guidelines are based on unit time, using inpatient time requirements. When prolonged service codes are applied to observation codes, CPT® also directs that the inpatient prolonged services codes should be used. Therefore, time for observation and associated prolonged services would be floor time, more liberal than the face-to-face outpatient time requirements. This is inconsistent and confusing, but is a positive step in the use of time-based coding for observation services. Inpatient time criteria includes reviewing time you spend reviewing the chart before you see the patient, talking to the nurse, reviewing test results, and other time on the unit that goes beyond outpatient face-to-face patient/physician time requirements.

Take Note of New Otoacoustic Testing Codes

You'll also find a few changes this year if your practice performs services for hearing disorders, with the following adjustments included effective Jan. 1, 2012:

CPT® will introduce new code 92558 (Evoked otoacoustic emissions, screening [Qualitative measurement of distortion product or transient evoked otoacoustic emissions], automated analysis) effective Jan. 1. The following revised codes will be listed after it:

• 92587--Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report
• 92588--...comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report

Good news: There has been a recent encouraging report of payers reimbursing for the above services on a restricted basis.

In addition, CPT® takes into account the length of time it takes to evaluate a patient for a non-speech generating communication device, adding time guidelines to code 92605 and offering a new add-on code for additional time, as follows:

• 92605--Evaluation for prescription of non-speech-generating augmentative and alternative communication device; face-to-face with patient; first hour
• +92618--...each additional 30 minutes (List separately in addition to code for primary procedure

The new, deleted, and revised CPT® codes take effect on Jan. 1, 2012. Keep an eye on Pediatric Coding Alert for updates on how the Correct Coding Initiative (CCI) will impact the new codes.