Pediatric Coding Alert

Surprise: E-visits become mainstream with CPT Category I code

Has the imprecise matching of simple, intermediate or complex to 99371-99373 made you shy away from using these codes? CPT 2008 will offer you a more straightforward method, as well as a new code for another office visit alternative and specific nonphysician counseling codes.

If the AMA CPT panel gives final approval, you can look forward to implementing these CPT changes for Jan. 1. The following is based on general information available. Code specifics could vary on publication.

Welcome Your Call Code Selection Getting Easier

Top one for pediatrics? "Three new codes for telephone E/M care have been proposed for 2008," said Joel Bradley Jr., MD, FAAP, a member of the AMA CPT Editorial Panel at The Coding Institute's 2007 Pediatric Coding & Reimbursement Conference. "The length of the call will determine which code to pick."

Benefit: You can forget figuring out telephone care complexity. Codes 99371-99373 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals ...) require you to decide if the call is simple/brief, intermediate or complex.
You may also have more guidance on which phone calls you should include as part of an E/M service and which you should separately report. The proposed telephone care codes will have a "global" period of seven days, Bradley says. If you treat the problem in the office within seven days before or after the phone call, you would not bill the telephone care.

Example: A mother calls to report that a sibling has developed the same problem as the other child you recently treated. If the pediatrician talks to the mother, in 2008 you could use a telephone care code based on time, rather than on complexity.

But the big question for practices will remain: Will payment make reporting the new telephone care codes worthwhile? CMS will need to publish RVUs (relative value units) for possible payment of the new codes to move forward, Bradley says. Check with payers about reimbursement.

Anticipate Acceptance of E-Visits

Another non-face-to-face service that may be coming into its own in 2008 is an "e-visit." Online E/M visits, consultations and Web-visits all fall under the term "e-visit," which is a structured non-urgent consultation between a doctor and an established patient conducted over the Net.

Change: Because e-mail service is no longer considered an "emerging technology" (temporary Category III codes), "there's been a move to make it a Category I code," Bradley says. If the service makes it into CPT 2008, it would replace the 2004-created CPT category III code (0074T, Online E/M service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient's request, established patient) for an emerging technology.

You're not behind the times if you're not doing online services. Most pediatricians aren't jumping aboard e-services due to risks associated with the pediatric population, Bradley says.

Get this: An informal poll during the Pediatric Coding & Reimbursement Conference in Naples, Fla., indicated no attending practices offered e-visits. "But the move to make e-mail services a Category I code shows the trend in other specialties to include these services," Bradley says.

If you consider providing e-visits, adhere to the e-visit's "global period." You can report the service only once during a seven-day period for any and all replies related to the patient's question. If you see the patient for the same problem within seven days of the online query, you should not bill the Internet communication. Instead, you would consider it part of the post-service work attached to the billed E/M service.

Payment: You'll have to wait until the 2008 Medicare Physician Fee Schedule comes out to see if CMS assigns RVUs to the Category I e-visit code. A limited number of private carriers now cover e-visits. Florida's Blue Cross Blue Shield offers coverage for "online office visits" and outlines their newly reviewed policy at the Web site http://mcgs.bcbsfl.com/index.cfm?fuseaction=main.main&stage=pub&format=cfm&doc=E-Medicine.

Consider Specific Quit-Smoking Codes

You might fret over the difficulty of getting paid for the numerous nonphysician counseling services your practice provides. But one of those services will no longer masquerade under the generic counseling and/or risk factor reduction intervention codes (99401-99412) (for patients with no symptoms or established illness) or health and behavior assessment/intervention codes (96150-96155) (for patients with disease-related problems).

Look for two Medicare-only smoking-cessation codes to become standard. The AMA will convert both G0375 and G0376 to CPT codes, which will be available Jan. 1, says Alan L. Plummer, MD, at Emory University School of Medicine in Atlanta. "The number of yearly visits allowed for these new codes has yet to be determined," he adds.

Plus: The new codes will be time-based. The current G codes, which Medicare restricts to patients who have documented tobacco dependence (305.1, Tobacco use disorder) and either a co-morbidity that smoking complicates or use a prescription drug that may lead to an adverse reaction/negative outcome as a result of continued smoking, include:

• G0375--Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

• G0376--... intensive, greater than 10 minutes.

Example: A 16-year-old with worsening asthma visits the nurse for smoking-cessation assessment and returns in one month for intervention beginning a cessation program. In 2008, if a payer doesn't cover 96150 (Health and behavior assessment [e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires], each 15 minutes face-to-face with the patient; initial assessment) and 96152 (Health and behavior intervention, each 15 minutes, face-to-face; individual) for this encounter, you could use a smoking- cessation counseling code based on time.