Pediatric Coding Alert

A number of new and revised CPT codes will affect pediatricians in 2002. The new manuals are due out this month, and the new codes are effective Jan. 2, 2002. Insurance companies have until April to implement the codes. The information in this article is preliminary; there may be a few changes later this month after the specialty societies meet for the AMA's coding symposium. Most of these changes are definite.
 
Note: Revised terminology is bolded. Eliminated verbiage is struck out.

Vaccine Administration
 
One revision and two additions reflect the distinction between routes of administration; there are now codes for oral or intranasal routes.
Revised code:
 

CPT 90471 immunization administration (includes percutaneous, intradermal,  subcutaneous, intramuscular and jet injections and/or intranasal or oral administration; one vaccine (single or combination vaccine/toxoid) Revised to exclude intranasal or oral administration

New codes:
 

90473 immunization administration by intranasal or oral route; one vaccine(single or combination vaccine/toxoid)
 

90474 ... each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure).

Medicine

Revised code:
 

90732 pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, or subcutaneous or intramuscular use.

Laboratory

New codes:
 

87802 infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group B
 

87804 ... influenza.

Behavior Assessment
 
Pediatricians may be impacted by a series of new behavior assessment codes:
 

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
 

96151 ... reassessment
 

96152 health and behavior intervention, each 15 minutes, face-to-face; individual
 

96153 group (2 or more patients)
 

96154 ...  family (with the patient present)
 

96155 ... without the patient present.

Special Reports
 
This new code should be used for monitoring a patient at home. Nonphysicians may use this code as well. Note that you must spend 30 minutes on one calendar day on the service before coding it.
 

99091 collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, requiring a minimum of 30 minutes of time.

Transport
 
Two new transport codes may impact practices that accompany critically ill babies to tertiary-care facilities:
 

99289 physician constant attention of the critically ill or injured patient during an interfacility transport; first 30-74 minutes
 

99290 each additional 30 minutes (list separately in addition to code for primary service).

Home Visits
 
A new E/M section on home visits includes some codes designed for nonphysicians. Pediatricians who perform home visits should use 99341-99350.
 

99502 home visit for newborn care and assessment
  

99503   ... respiratory therapy care (e.g., bronchodilator, oxygen therapy, respiratory assessment, apnea evaluation)
 

99504 ... patients receiving mechanical ventilation
 

99506 ... intramuscular injections
 

99509 ... assistance with activities of daily living and personal care
 

99510 ... individual, family, or marriage counseling
 

99539 unlisted home visit service or procedure
 

99551 home infusion for pain management (intravenous or subcutaneous), per diem
 

99554 ... hematopoietic hormones (e.g., erythropoietin, G-CSF, CM-CSF), or platelets ...
 

99555 ... chemotherapy ...
 

99556 ... antibiotics/antifungals/antivirals ...
 

99558 home infusion of immunotherapy ...
 

99560 ... enteral nutrition ...
 

99561 ... hydration therapy ...
 

99563 ... aerosolized pentamidine ...
 

99564 ... anti-hemophilic agents (e.g., factor VIII) ...
 

99568 ... miscellaneous drugs ...
 

99569 home infusion, each additional therapy given on same day (list separately in addition to code for primary visit).

Modifier -60 Deleted
 
Pediatricians who use modifier -60 (altered surgical field) to signify extra work (i.e., due to the size of a neonate) should change to modifier -22 (unusual procedural services). CPT 2001 created modifier -60. CMS refused to recognize it, contributing to its quick elimination.