Pediatric Coding Alert

The American Academy of Pediatrics (AAP) is working on a new modifier that will increase reimbursement to pediatric surgeons for procedures based on either the age or weight of a child. This modifier will have a new number entirely and will probably be strictly for infant surgery.
 
Pediatricians had hoped to access modifier -60 (altered surgical field), introduced in CPT Codes 2001. This modifier was approved for neonates but had a short life when CMS (formerly HCFA) announced that it would not recognize it.
 
Any plea by pediatricians for a special system to reimburse them for difficult cases is likely to be resisted by payers.
 
For example, pediatric gastroenterologists believe that a sigmoidoscopy on a 6-month-old deserves higher payment than an adult sigmoidoscopy, says Charles Schulte, III, MD, FAAP, the AAP's representative to the AMA's CPT advisory committee and chairman of the AAP coding and reimburse-ment committee. But other specialists, such as gerontologists, might retort that a sigmoidoscopy on an 82-year-old involves a lot of difficulty as well.