Pediatric Coding Alert

Here are six additional code changes in CPT 2000 that will affect pediatricians (see also Pediatric Coding Alert, November 1999, pages 81-82).

1. Modifier -51. CPT 2000 has introduced a new symbol, the circle with a slash, to indicate that a -51 modifier should not be used. This symbol appears on the vaccine codes.

Therefore, in listing multiple vaccine codes you should not use the -51 modifier on the vaccines following the first vaccine. (This has always been true, but apparently CPT felt it was necessary to emphasize the point.) The -51 modifier is for multiple procedures and indicates you expect to be paid half the normal amount for this item.

2. Critical care codes. In the introduction to the critical care codes, 99291 and 99292, note that the pediatric intensive care unit has been added as a place of service. A whole paragraph was added to clarify the relationship of the neonatal codes and the critical care codes (see below).

A new sentence emphasizes that the physician, while not necessarily at the bedside, must be devoting his or her full attention to the critically ill patient. Also note a new emphasis on 99291 being used only after the first 30 minutes. Time of less than 30 minutes should be reported with an E/M codes (this was always true, but confusing before the rewording.)

Critical care services provided to infants older than one month of age at the time of admission to an intensive care unit are reported with critical care codes 99291 and 99292. Critical care services provided to neonates (30 days of age or less at the time of admission to an intensive care unit) are reported with the neonatal critical care codes 99295, 99296, 99297 and 99298.

The neonatal critical care codes are reported as long as the neonate qualifies for critical care services during the hospital stay. The reporting of neonatal critical care services is not based on time, the type of unit (e.g., pediatric or neonatal critical care unit) or the type of provider delivering the care.

3. Procedures bundled into neonatal codes. In the neonatal codes introduction, a new paragraph bundles all the adult critical care procedures into the neonatal codes.

The same definitions for critical care services apply for the adult, child and neonate. The neonatal critical care codes, however, are global 24-hour codes and not reported as hourly services. Services for a patient who is not critically ill but happens to be in a critical care unit are reported using other appropriate E/M codes.

4. High-risk Hepatitis B deleted. 90745 has been deleted, leaving only the lower-paying code (90744) for Hepatitis B injections.

5. Prophylactic injections. For 90782, 90784 and 90799, the word prophylactic has been added to emphasize that these shot administration codes should be used with immune globulins.

6. Screening tests and preventive medicine codes. In the last paragraph of the introduction to the preventive medicine codes (99381-99385, 99391-99395), the phrase or screening tests identified with a specific CPT code was added. This emphasizes that the vision and hearing screening tests should be billed separately.