Pediatric Coding Alert

Question: I've heard that CPT has a new code for reviewing records separate from an appointment. Is this true? If so, what do we need to know before reporting it?

Massachusetts Subscriber

Answer: CPT 2010 doesn't include new codes for records review, but already has three codes in place for those situations. The most helpful option for pediatricians is 99358 (Prolonged evaluation and management service before and/or after direct [face-toface] patient care; first hour). Code 99358 applies to non faceto- face services of 30 to 75 minutes.

Similar choices include 99455 (Work related or medical disability examination by the treating physician ...) and 99456 (Work related or medical disability examination by other than the treating physician ...)

The descriptors for 99455 and 99456 include examples of the services covered, such as completion of a medical history commensurate with the patient's condition; development of future medical treatment plan; completion of necessary documentation/certificates and report; and more. Codes 99455 and 99456 apply to some situations, but don't really apply to pediatrics because they focus on "work related" situations.

Document: The physician must itemize the total time spent reviewing the patient's medical records before you can specifically code the service.

Detail: In the past, physicians could only report prolonged non face-to-face services on the day of an E/M visit. Now, however, you can code the non face-to-face prolonged services on the days before and/or after an E/M visit. Be sure to associate code 99358 with a face-to-face E/M visit.