Pediatric Coding Alert

You’ll also see changes to 99420 reporting.

Coding vaccines based on the patient’s age can be an easy task—simply match the vaccine descriptor to the patient’s birth date and you can easily select the right code. But once the calendar turns to 2017, you won’t have that option—many of the vaccine codes in CPT^® will convert to coding based on the dosage of the immunization that you administer rather than the patient’s age.

Caution: These updates are based on the preliminary list of updates, and changes may occur before the code set is final. Keep checking back in to Pediatric Coding Alert for news about the final codes and details on proper use of your updated options.

Look for Dosage, Not Age

Currently, when you administer a trivalent flu vaccine without preservatives, you report 90655 for patients under age three, and 90656 for those who are age three or older. Starting in 2017, however, you’ll look to 90655 when the practitioner administers 0.25 mL of the vaccine, and 90656 for vaccines of 0.5 mL or greater because all of the age specifics are no longer applicable.

Following are the vaccine code changes that will impact pediatric practices the most, with the changes highlighted using strikethroughs to identify verbiage that will be deleted in 2017 and underlining to show text that’s new effective Jan. 1:

CPT^® will also debut a new influenza code with 90674 (Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use). CMS notes that this code is payable “for claims with dates of service on or after Aug. 1, 2016, processed on or after Jan. 3, 2017,” according to MLN Matters article MM9793. Although most pediatric practices don’t bill Medicare for their services, many private payers follow Medicare’s lead, so this could be the case with your private payers as well. Always ask your insurers for details on when specific codes go into effect.

Scratch 99420 From Superbills

In addition to the vaccine changes, CPT^® has also deleted 99420 (Administration and interpretation of health risk assessment instrument [eg, health hazard appraisal]). “This code has been used frequently by pediatric practices for our maternal depressions as well as some health risks like lead and concussion screening,” says Donelle Holle, RN, president of Peds Coding, Inc.

Instead, when you perform screenings, you’ll select from among the following two new codes, which go into effect on Jan. 1:

• 96160 — Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument
• 96161 — Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument

As the descriptors indicate, these codes will more accurately indicate who the subject of the assessment is—the patient versus the caregiver. “It may also be easier to get paid for these two codes versus the 99420 when done with another E/M code,” Holle says. “With the 99420 being an E/M code, many times it was paid and the visit itself was bundled into the payment for the 99420.” It is unclear what type of RVUs will be assigned to the new codes, but keep an eye on Pediatric Coding Alert for more on these codes as payers release information about how to report them.