Pediatric Coding Alert

Plus: Changes throughout CPT's E/M section bring non-physicians to the forefront.

If your pediatrician aims to promote well-rounded primary care, CPT® helps out in 2013, with the addition of several codes for transitional care, care coordination, and patient transport.

Last month, Pediatric Coding Alert updated you about the upcoming vaccine changes that will impact your pediatric practice in 2013. This month, you'll find a whole lot more to cheer about with additional news regarding how the new edition of CPT® effective Jan. 1 will help you code more accurately.

CPT® Tweaks E/M Verbiage

Many pediatric practices use E/M codes more often than any other code series in CPT®, and you'll find revised descriptors for the vast majority of these codes in 2013.

Whereas most E/M codes previously referred to "physicians" and "providers" in their descriptors, that will change effective Jan.1, when the descriptors will instead say "qualified health care professionals" as distinguished from "physicians."

Taking 99213 as an example, the code changes are indicated with the strikethroughs (indicating deleted text) and underlining (indicating new text) as follows: "Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other providersqualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spendTypically, 15 minutes are spent face-to-face with the patient and/or family."

What this means: "They are clarifying that all E/M codes can be reported by physicians or other qualified health care providers and changed the wording with regard to time in each of the codes--which really has no bearing on how the codes are used, just that the typical time is spent by all qualified providers who bill these codes," says Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M. "In other words, if a payer allows someone other than a physician to provide and bill for a service, the CPT® E/M codes are used by all providers who qualify."

Time assignment: In addition, CPT® will add typical times to the same-day observation or inpatient admission and discharge codes 99234-99236, assigning 40 minutes to 99234, 50 minutes to 99235 and 55 minutes to 99236. Previously, these codes did not have typical times associated with them, so this change could be helpful to physicians who are at the patient's bedside or on the unit counseling or coordinating care for more than half of the visit, which would allow them to select a code based on time.

Care Coordination Codes Could Help You

The new care coordination services, which will be described by new codes 99487-99489, are described as follows:

• 99487 -- Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with no face-to-face visit, per calendar month
• 99488 -- .....with one face-to-face visit, per calendar month
• 99489 -- ...each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

In addition, CPT® will introduce two codes under the "transitional care management" heading, as follows:

• 99495 -- Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge, Medical decision making of at least moderate complexity during the service period, Face-to-face visit, within 14 calendar days of discharge
• 99496 -- Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge, Medical decision making of high complexity during the service period, Face-to-face visit, within 7 calendar days of discharge

CPT® has not yet released examples of how these new codes will be utilized, and CMS has not assigned RVUs to the new codes yet. However, most coding experts agree that the codes will be used for patients with multiple health conditions who require ongoing care in addition to their E/M and procedural services.

Record This Change for Online Evaluation

Although it's a subtle change, you may notice a major difference in how you can report the online evaluation code 99444. The descriptor effective Jan. 1 will read, "Online evaluation and management service provided by a physician to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network."

The difference is that CPT® will be removing the current verbiage that allows you to bill this code when performing an online E/M service with a patient's health care provider. The words "health care provider" have been stricken from the descriptor completely.

Interfacility Transport Management Coding Will Change

If the pediatrician spends a significant amount of time overseeing the transport of critically ill or injured patients, CPT® has good news with the addition of two new codes that will help you report these services, as follows:

• 99485--Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data interpretation and report; first 30 minutes
• +99486--...each additional 30 minutes (List separately in addition to code for primary procedure)

You'll use these codes when your pediatrician is designated as the "control physician" who oversees the transfer, and you'll count the time starting at the first contact with the team, and ending after care is handed over to the receiving facility team, advises Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville.

If the patient is over the age of two, you'll forego these new codes and instead report 99288, which has been revised for 2013 to read, "Physician direction or other qualified health care professional direction of emergency medical systems emergency care, advanced life support."

Take Note of New Pharmacologic Management Code

Overseeing a patient's medication management for prescriptions such as Adderall might currently prompt you to report 90862 (Pharmacologic management, including prescription use, and review of medication with no more than minimal medical psychotherapy). But that will change effective Jan. 1, when this code is deleted.

Instead, you'll report +90863 (Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services [List separately in addition to code for primary procedure]). This new add-on code is meant to be paired with a psychotherapy code such as 90832 (Psychotherapy, 30 minutes with patient and/or family member).

Reality: Since your pediatrician is probably not performing 30 minutes or more of psychotherapy, you will most likely roll your medication management services into E/M codes going forward.

Up next month: We'll show you the changes you'll want to make when reporting neonatal and pediatric critical care that will impact your practice in 2013. Plus, we'll fill you in on how to code sleep studies for your pediatric patients in 2013.