Pediatric Coding Alert

More and more patients are getting treated at home instead of in the hospital, and newborns are no exception. Managed care would rather not spend the money on inpatient treatment unless it is absolutely necessary; also, parents would much rather have their new babies at home. However, this does make extra work for the pediatrician, as Julie Sanders, office manager for the Southern Sierra Medical Clinic in Ridgecrest, CA notes. The pediatrician is spending a minimum of 30 minutes per day reviewing follow-up lab results and spending time on the phone with the family, she writes. Please advise as to which code a physician may use to manage the care of a newborn who is receiving phototherapy in the home for hyperbilirubin. We talked to three office managers for an answer.

1. See the patient. Put simply, if the baby comes into your office, you can bill for an office visit. Otherwise, its going to be difficult to get reimbursed for much, says Jeannine Bailey, CMA, practice manager for Londonderry Pediatrics, a four-pediatrician practice in Londonderry, NH. We always have the baby come in from home to see the pediatrician before ordering the home therapy, says Bailey. If the baby left the hospital with high bilirubin, we want to make sure that feeding is going well, she notes. The nurse then makes all the arrangements for the home therapy.

For this office visit, Bailey usually uses CPT 99213 . This one code must cover the costs of any subsequent days of treatment in terms of the pediatricians time, says Bailey. But it doesnt have to be that much time, she notes. We send the baby to the lab on an outpatient basis for the tests, she says. Then when we get the results, which the lab either phones in or we can get off the computer. The pediatrician decides whether the phototherapy should be continued or stopped.

The parent must be called with the results as well as the home health care agency, but the nurse can make these calls, says Bailey. There is some training involved to enable the parents to use the phototherapy equipment, and while the pediatrician goes over some of this during the office visit, the home health agency does most of the training as well as the equipment set-up, says Bailey.

2. Telephone and care plan oversight codes. The telephone call codes dont work, says Tanya Mathews, accounts manager for Newborn Services, a five-neonatologist practice in Columbus, OH. We often supervise phototherapy at different sites, says Mathews. We need to bill for it because the doctor spends a lot of time coordinating with the parents and talking to the nurse on the unit, the accounts manager says. And if its being done at home, it means talking to the home health care person too. The telephone codes99371, 99372, and 99373seem ideal for this, says Mathews. For example, 99371 is for a telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionals. This code is for simple or brief calls, such as reporting on laboratory results, altering previous instructions, or adjusting therapy. Intermediate calls (99372) are for more detailed discussions and advice, and complex calls (99373) are for lengthy communication for coordination of services or lengthy counseling with distraught patients or family members.

We tried the telephone codes for a while, but now were moving to the care plan oversight codes, says Mathews. These are reported for the total time spent within a 30-day period. However, to use these in conjunction with home health care agencies, make sure that recurrent supervision of therapy is existing. Care plan oversight codes are 99374 for 15 to 29 minutes, and 99375 for 30 minutes or more. Again, these are cumulative, so that if a pediatrician spends five minutes on Monday, ten minutes on Tuesday, and ten minutes on Wednesday coordinating phototherapy, for a total of 25 minutes in the 30-day period, you would code 99374 once. Care plan oversight is for physician supervision of a patient under care of home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professional involved in patients care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month.

Tips: Only one physician per month can report care plan oversight for a single patient. The assigned physician should report the code, regardless of which physician from the practice does the work. Also, the documentation for this code must be golden. The hardest part of using care plan oversight codes is there can be no question about the fact that you spent your time doing this. Keep a separate sheet recording your time, with date and with whom you talked. For more information on using care plan oversight codes, see the article on the cover of the April 1998 issue of PCA.