Pediatric Coding Alert

Plus: You'll find clarification on developmental testing codes 96110-96111.

Last year, coders received a good dose of updates--and confusion--with the addition of several new vaccine administration codes. This year CPT® takes it easier on pediatric practices with a few changes to the code set which will create the need for updates, but not overhauls.

At the top of the list this year, you'll find the following new codes for car seat testing:

• 94780 -- Car seat/bed testing for airway integrity, neonate, with continual nursing observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes
• +94781 -- ...each additional full 30 minutes (List separately in addition to code for primary procedure)

"The car seat testing services will primarily be done in facility settings, but will be valued with facility and non-facility payment amounts," says Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville. These tests are typically required before premature or at-risk babies (with conditions such as heart disease or congenital malformations) are discharged home from NICU settings.

"There are occasions where follow-up testing may be indicated," Tuck says. "This would typically be provided in a neonatal follow-up clinic, but could be done in the office setting, if the setup is complete to provide all the requirements for the code. As more services move to the medical home, this could happen more in the future. Having the codes and the anticipated relative value payments should facilitate the process."

Developmental 'Testing' Changes to 'Screening'

New codes are always great to find in CPT®, but sometimes you'll find changes that make important clarifications to existing codes. Such is the case with existing developmental testing codes 96110-96111. The new descriptors for these codes are listed below:

• 96110 -- Developmental screening, with interpretation and report, per standardized instrument form
• 96111 -- Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments), with interpretation and report

These changes are significant in that CPT® 2011 lists both codes as developmental "testing" codes, with 96110 referring to "limited" testing and 96111 describing "extended" tests. Now the descriptors more closely relate to how practices actually refer to these codes, since many doctors document "screening" when they perform the services described by 96110.

Take Note of Vaccine Revisions

Last year, CPT® threw many practices for a loop with the addition of several new vaccine administration codes, which most payers finally began processing smoothly within the last few months. Fortunately, such a major overhaul has not taken place this year. Instead, CPT® makes a few minor adjustments to how you'll report your vaccines.

For instance: CPT® will change meningococcal conjugate vaccine code 90644 to remove mention of "Hib-MenCY-TT." Instead, the new code descriptor reads "Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine (Hib-MenCY), 4-dose schedule, when administered to children 2-15 months of age, for intramuscular use." The tetanus is an adjuvant in the vaccine and not an active vaccine antigen component. Therefore, this would be considered a two-component vaccine. Administration for this would be one unit of code 90460 and one unit of +90461.

In addition, CPT® has made some minor changes to two codes that were new in 2011, with the descriptors changed as follows:

• 90460 -- Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered
• +90461 -- ...each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)

Note that by adding the phrase "first or only component," 90460 now clarifies that when the physician only administers one component, 90460 is still valid. In addition, CPT® offers advice in the introductory notes to the Vaccine Immunization section stating, "Report codes 90460 and 90461 only when the physician or qualified health care professional provides face-to-face counseling of the patient/family during the administration of a vaccine." If the physician does not provide face-to-face counseling, report a code from the 90471-90474 range instead.

CPT® Defines 'Other Qualified Healthcare Professional'

At the request of many physicians, CPT® 2012 now defines the term "other qualified healthcare professional." Although this definition didn't make it into the 2012 manual, the AMA lists it as part of the "CPT® 2012 Errata" on its Web site (www.ama-assn.org/resources/doc/cpt/cpt-2011-corrections.pdf) and the definition is as follows:

"A 'physician or other qualified health care professional' is an individual who by education, training, licensure/regulation, and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports a professional service. These professionals are distinct from 'clinical staff.' A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service. Other policies may also affect who may report specified services."

Pediatricians may be disappointed that RNs and LPNs aren't included in the definition, because it means that CPT® will now preclude RNs and LPNs from reporting certain codes that are meant for physicians and "other qualified healthcare professionals" -- for instance, immunization administration codes 90460-90461.

Get to Know New Flu Vaccine Code

You may be cheering the addition of a new flu vaccine code in CPT® 2012, but once you read the fine print, the "new" code may reflect "old" news.

The AMA introduced code 90654 (Influenza virus vaccine, split virus, preservative-free, for intradermal use) effective Jan. 1, 2011, but it was too late to make it into the 2011 CPT® manual. Therefore, the code makes its first appearance in CPT® 2012, even though you've probably already reported it.

Check it out: CMS has already assigned a relative value to 90654--this flu season, you'll collect $18.383 in Medicare-equivalent payment for the preservative-free split virus for intradermal use.