Pediatric Coding Alert

CPT also changes pediatric transport code bundles effective in 2011.

Get ready for a whole new crop of bundles with pediatric critical care and transport services in 2011. In fact, CPT has gone retro with pediatric critical care transport codes 99466-99467, reverting the bundles back to the 2007 rules.

That's the word from Peter A. Hollmann, MD, vice chair of the CPT Editorial Panel, who outlined the changes during his presentation on E/M, Vaccines, and Time-Based Codes at the AMA CPT Symposium in Chicago last month.

At issue: Effective Jan. 1, CPT will change which services are bundled into critical care codes 99291-99292 based on whether a facility or professional reports the services. Plus, CPT will return the list of services bundled into 99466-99467 to the bundles that were in effect as of 2007, Hollmann said.

Pediatric transport: Starting in 2011, "the following services are included when performed during the pediatric patient transport by the physician providing critical care and may not be reported separately," Hollmann said:

• Routine monitoring evaluations (eg, heart rate, respiratory rate, blood pressure, and pulse oximetry)
• Interpretation of cardiac output measurements (93562)
• Chest x-rays (71010-71020)
• Pulse oximetry (94760-94762)
• Blood gases and information data stored in computers (e.g., ECGs, blood pressures, hematologic data - 99090)
• Gastric intubation (43752-43753)
• Temporary transcutaneous pacing (92953)
• Ventilatory management (94002-94003, 94660-94662)
• Vascular access procedures (36000, 36400-36406, 36415, 36591, and 36600)

Critical care: In 2011, pediatricians from your practice will still face the following services as being bundled into critical care: interpretations of cardiac output measurements, chest xrays, pulse oximetry, blood gases, information data stored in computers (such as ECGs and blood pressures), gastric intubation, temporary transcutaneous pacing, vent management, and vascular access. However, facilities will be able to report these services separately from critical care and will not face the bundles.

Keep in mind: This means that you can report the critical care code only, even if the facility is reporting the critical care codes as well as the separate x-rays, intubation, and other services separately.

Avoid Reporting New Observation Care Codes With Other E/M

As we reported in the October 2010 Pediatric Coding Alert, you'll have new offerings when it comes to coding subsequent observation care, thanks to the addition of 99224-99226 to CPT 2011. Although confusion surrounded these new codes when CPT first debuted them, some rules have recently come to light about how you can report them.

When to bill: Subsequent observation care begins after the initial observation care date of service, Hollmann said during the CPT meeting.

Plus: You should not report subsequent observation care on the same date as initial observation care codes (99218-99220), nor can you report observation services on the same date as office or emergency department services, Hollmann said. In addition, you can't report the new subsequent observation codes on the same date as observation care discharge (99217).

Timed codes: You may have been puzzled when you opened your 2011 CPT manual and saw that the new subsequent observation care codes have typical times associated with them -- this is a new feature that only applies to the new codes, Hollmann said. If you require the use of prolonged service codes in addition to the observation care codes, you should look to 99356-99357 (Inpatient prolonged services), even though observation care is not technically "inpatient," Hollmann said.

Use the unit/floor time that your physician spends as your guide in reporting these services, also in the inpatient coding guideline. CPT clarified that when reporting outpatient time-based codes, you should use the face-to-face time for office-based E/M services because most of the work of a typical office visit takes place while the practitioner is with the patient. However, when reporting timed codes in a facility, the physician should count unit/floor time, since most of the work takes place on the patient's floor or unit during inpatient E/M visits, Hollmann clarified. This supports the new perspective on observation time-based coding, which although considered outpatient codes, are provided in a facility.