Pediatric Coding Alert

Experts weigh in on the latest revisions.

The good news about the new and revised codes CPT^® codes for 2022 is that you’ve seen most of them already. Many, such as the Clinical Laboratory Improvement Amendments (CLIA)-waived COVID-19 tests and the COVID-19 vaccination codes, first appeared last year as a response to the public health emergency (PHE) and are still in effect, even though they are making their first formal appearances in the CPT^® code set.

But there are some changes, such as the one to 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.), which you will need to pay careful attention to when they take effect on Jan. 1, 2022.

So, whether you’re reviewing old codes that the AMA has already implemented, or you’re dealing with new codes, we’ve got you covered.

Don’t Minimize This Office/Outpatient E/M Change

One immediate change, which will take effect on Jan. 1, 2022, is the deletion of the words “usually, the presenting problem(s) are minimal” from the code descriptor for 99211. “The reason for the deletion is an editorial revision to bring the descriptor for 99211 more into line with the rest of the office/outpatient evaluation and management (E/M) codes (99202-99215). The descriptors for those codes prior to 2021 all included a sentence that read, ‘Usually, the presenting problem(s) are....’ Now, they don’t,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

“This change also removes a potential source of confusion,” says Cindy Hughes, CPC, CFPC, consulting editor of Cindy Hughes Consulting in El Dorado, Kansas. “For instance, 99211 may be reported when a nurse provides education to a newly diagnosed diabetic, but diabetes is by no means a minimal problem.”

In other words, even with the change, “99211 still represents an E/M (really an assessment and management) service provided by clinical staff as opposed to a physician or other qualified healthcare professional who may report higher levels of E/M services. Services described by 99211 must be medically necessary (i.e., clinically indicated) and be part of a plan of care by a physician or other qualified healthcare professional. This is why 99211 is not reportable for measuring a patient’s blood pressure at their request rather than per an established plan of care,” Hughes elaborates.

Reconsider These Old COVID-19 Tests

As always, the AMA has introduced numerous new pathology and laboratory codes, but the only ones of real interest for peds coders are not new codes at all. The following codes are all CLIA-waived COVID-19 tests that you have seen, and possibly even used, already:

• 87428 (Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B), introduced in November 2020;
• 87636 (Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique) and 87637 (… severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique), both introduced October 2020; and
• 87811 (Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])), also introduced in October 2020.

And Review These Old Vaccine and Administration Codes

Similarly, all the COVID-19 vaccine administration and vaccine codes that are new to CPT^® 2022 are codes that you should already be familiar with, as many have been active since late last year:

Other codes of interest to pediatrics that are active now include vaccines that received CPT^® codes in July. Two of them are pneumococcal vaccines: 90671 (Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use), which is still awaiting FDA approval, and 90677 (Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use). Another is a new tick-borne encephalitis vaccine with two dosage variations: 90626 (Tick-borne encephalitis virus vaccine, inactivated; 0.25 mL dosage, for intramuscular use) and 90627 (… 0.5 mL …), which is also awaiting FDA approval.

Also of interest is a brand-new Hepatitis B vaccine: 90759 (Hepatitis B vaccine (HepB), 3-antigen (S, Pre-S1, Pre-S2), 10 mcg dosage, 3 dose schedule, for intramuscular use). But you will have to wait before using it: not only will it not become active until Jan. 1, 2022, but it is also awaiting FDA approval.