Pediatric Coding Alert

Know what to mark up, and what to leave alone, in your old coding books.

Even though 2018 was another year of rapid change in the world of healthcare, some things, like coding myths, seem to stay the same. The annual flood of revisions, deletions, and additions to the codes you use on a daily basis can create confusion and misunderstanding at best and, worse, contribute to flawed documentation and denied claims.

Staying on top of everything isn’t easy, so to help, we put together this list of three myths that have recently begun circulating in the coding world and asked our experts to bust them.

Read on, and make sure you have a firm understanding of recent changes as you begin the New Year.

Myth 1: Cyberbullying Is Too New to Have a Diagnosis Code

This first myth is easily busted. When the 2019 ICD-10 revisions took effect on October 1, 2018, the Centers for Disease Control and Prevention (CDC) added new conditions to T74.3 (Psychological abuse, confirmed) and T76.3 (Psychological abuse, suspected). Specifically, the codes now include bullying, intimidation, and intimidation through social media (or cyberbullying).

Since their introduction, coders have overwhelmingly welcomed these new additions to the external cause codes, and not just because they acknowledge a rapidly growing problem. “It is huge to finally have a code for bullying and social media intimidation, especially as the codes will now be able to put data to what’s known to be a problem,” says Jan Blanchard, CPC, CPMA, pediatric solutions consultant at Vermont-based PCC.

Coding note: Remember to look for the words “confirmed” and “suspected” in your provider’s notes to determine whether to use T74.3 (… confirmed) or T76.3 (… suspected). And don’t forget to add the appropriate fifth character, 2, to document that your patient is a child.

Myth 2: 96101-96103 Are Still the Go-To Psych Test Codes

Since January 1, this has become another busted coding myth. “The codes were deleted as part of extensive revisions to the Medicine/Central Nervous System Assessments/Tests subsection of CPT^® 2019 to better reflect current practice,” according to Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

In their place, you’ll need to add a slew of new codes “that better allow for differentiating between tests administered by a physician or qualified health care professional [QHP] on one hand or by clinical staff on the other, and distinguishing between stand-alone, single-computer screening tests and other psychological and neuropsychological testing,” Moore notes.

The codes are:

• 96136 — Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes
• +96137 — … each additional 30 minutes (List separately in addition to code for primary procedure)
• 96138 — Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes
• +96139 — … each additional 30 minutes (List separately in addition to code for primary procedure)
• 96146 — Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only.

The inclusion of these neuropsychological codes in the pediatric setting will allow your pediatrician — or, as is becoming increasingly common, a psychologist within the pediatric practice — to continue to evaluate numerous developmental issues in your young patients. These include such areas as language and cognition in preschoolers, and social functioning, emotional wellbeing, and academic progress in school-age children and adolescents.

The only difference with the new codes is that “you will now report the same services but in a different way. Test administration (96136-96139/96146) is separated from evaluation (interpretation and report) (96130/+96131). Also, in the case of 96136-96139, additional time is reported with add-on codes rather than multiple units of a single code,” Moore explains.

In addition, CPT^® introduced a second set of codes that now allow you to describe the services your physician provides beyond the testing to incorporate care planning and treatment:

• 96130 — Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour
• +96131 — … each additional hour (List separately in addition to code for primary procedure)
• 96132 — Neuropsychological testing evaluation services …; first hour
• +96133 — … each additional hour (List separately in addition to code for primary procedure).

Myth 3: This Year, There Will Be 2, or Maybe 3, E/M Levels

This myth has been circulating ever since the Centers for Medicare and Medicaid Services (CMS) published the proposed Medicare Physician Fee Schedule (MPFS) for CY 2019 on July 12, 2018. That original fact sheet contained a proposal for “new, single blended payment rates for new and established patients for office/outpatient E/M level 2 through 5 visits and a series of add-on codes to reflect resources involved in furnishing primary care and non-procedural specialty generally recognized services” (Source: s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf).

However, we recently reported that with the publication of the MPFS Final Rule, CMS has decided not to follow through on this proposal to blend levels two through five. “There will be no changes to evaluation and management [E/M] payment or basic E/M documentation requirements until January 1, 2021,” reports Moore.

Instead, to add to the confusion, the Final Rule contained other proposals, including determining E/M levels using time or medical decision making (MDM), and blending levels two through four with separate reimbursement rates for current levels one and five and additional add-on HCPCS G codes for extended services.

For now, however, there will be no change to the current office/outpatient E/M levels “to give the physician community more time to work with CMS on this issue,” Moore believes.