Pediatric Coding Alert

Get ready for January 1, 2020, with this quick guide to the latest CPT^® revisions.

CPT^® 2020 contains a number of key revisions to many of the codes you frequently use to document your pediatrician’s monitoring of patient’s blood pressure and other physiological data such as pulse oximetry and pulmonary function.

Oh, and did we mention that there are also some new vaccine codes that will affect your coding next year as well? Read on and prepare your practice for all of these significant changes.

Blood Pressure Monitoring Codes Updated

As more than one in seven 12- through 19-year-olds in America are estimated to have hypertension or elevated blood pressure according to the Centers for Disease Control and Prevention (CDC) (source:  www.cdc.gov/bloodpressure/youth.htm), there’s a good chance that you have already encountered the ambulatory blood pressure monitoring (ABPM) 93784-93790 code group. If so, you’ll need to note that CPT^® has changed the root descriptor wording for the codes.

Beginning on January 1, the codes will no longer read Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer. Instead, to reflect recent changes in digital technology, they will now read Ambulatory blood pressure monitoring, report-generating software, automated, worn continuously for 24 hours or longer.

The change acknowledges that the codes are now almost 30 years old, and that blood pressure readings and other physiological data are no longer stored on disks or tape.

Coding caution: The change also now specifies that the patient must wear the ABPM device continuously during the 24-hour monitoring period.

CPT^® 2020 also sees the introduction of two brand new self-measured blood pressure (SMBP) monitoring codes:

• 99473 (Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration)
• 99474 (… separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care profes­sional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient).

The codes will “reimburse the physician or advanced practice provider (APP) for the monitor setup and the collection and interpretation of data from the monitor for patients with hypertension and who are asked to take SMBP readings at home,” says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

This also has a great benefit for the patient, as blood pressure readings taken in the clinical setting can often be inaccurate due to white coat hypertension, a phenomenon that happens when a patient’s blood pressure is higher in the clinical environment than it is outside it, and masked hypertension, a condition where the patient’s blood pressure is the opposite — higher outside of the clinical environment than in it. Because the patients being monitored are going about their normal routine when measurements are being made, readings obtained through ABPM and SMBP provide a more accurate representation of the patients’ blood pressure.

RPM Gets New Time Increments

CPT^® has also revised the codes for remote physiological monitoring (RPM), another form of patient monitoring. However, the revision is a simple change in the parent code’s time parameters, resulting in the change of the descriptor for 99457 from 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 to Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes.

You’ll also be able to report additional 20-minute increments of your provider’s RPM service time with 99458 (… each additional 20 minutes (List separately in addition to code for primary procedure)). The code should prove a welcome addition, as “the additional time allowed by this code should not only prove particularly beneficial for patients requiring significant monitoring and interaction during a particular month, but also allow your provider to capture the additional work spent on those patients,” according to Falbo.

Coding caution: “As there are new time components to 99457 and 99458, coders will need to work with their providers to ensure that they are documenting the time factors correctly,” advises Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. “The provider will need to be specific in the documentation as opposed to the previous requirement of noting ‘more than 20 minutes,’ so this will be an opportunity for education,” Johnson adds.

This could also be an opportunity to introduce a template for the service that your provider can use to capture all the time accumulated during the month and to store documentation that demonstrates what was performed during that time period.

2 New Vaccine Codes Introduced, but Remain on Hold

As in previous years, CPT^® 2020 introduces several new vaccines, including 90694 (Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use) and 90619 (Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY-TT), for intramuscular use).

Technically, neither code is new. The American Medical Association (AMA) actually introduced 90694 on July 1, 2019, initiating a six-month implementation period that ends on January 1 when the code becomes effective. And 90619 has been effective since July 1, 2019. But you will have to wait to use either one, as both 90619 and 90694 are awaiting Federal Drug Administration (FDA) approval as indicated by the lightning bolt symbol that CPT^® has placed next to the codes to denote “FDA approval pending.”

1 Vaccine Gets a Revision

Similarly, another CPT^® 2020 meningococcal conjugate vaccine code is not new. AMA implemented a revision of 90619 on January 1, 2019 to take effect on July 1, changing its descriptor from Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent (MCV4 or MenACWY), for intramuscular use to Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, diphtheria toxoid carrier (MenACWY-D) or CRM197 carrier (MenACWY-CRM), for intramuscular use.

The revision seems to be an attempt on CPT^®’s part to differentiate between the two conjugate carrier codes, emphasizing that the conjugate carrier protein in 90619 is the tetanus protein, while for 90734, it is the diphtheria protein.