Pediatric Coding Alert

Question: Our pediatricians offer a monthly asthma education service to current patients and their parents. Does a CPT code describe this service?


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Answer: No. CPT does not contain a specific asthma education code. Because the pediatrician provides the education in a group setting, you may, however, use 99078 (Physician educational services rendered to patients in a group setting [e.g., prenatal, obesity, or diabetic instructions]). For the ICD-9 code, report the asthma diagnosis, such as 493.00 (Extrinsic asthma unspecified).

If the physician instead offers individual asthma education, you would report the appropriate-level E/M service.

Tip: When counseling dominates the direct encounter, use time as the key factor in selecting the code. Make sure the pediatrician documents the total (T) visit time, the counseling (C) time, and the discussion topic.

Example: A child is refusing to use his inhaler at school. The pediatrician spends the entire 15-minute visit discussing the child's feelings and the importance of adhering to the doctor's orders. Documentation states, "15T/15C inhaler use." You would use time as the key factor and report 99213 (Established patient office visit ... physicians typically spend 15 minutes face-to-face with the patient ...).
 
Be careful: If a nurse provides the asthma education, don't report 99078. This code requires "physician educational services." You should instead assign 99211.

Nurses are not permitted to perform higher-level E/M services. To code 99212-99215 or 99078, the nurse would have to be a nonphysician practitioner, such as a nurse practitioner.

Answers to You Be the Coder and Reader Questions reviewed by Victoria S. Jackson, CEO of Southern Orange County Pediatric Association with five pediatric offices and 11 pediatricians in California; and Richard Tuck, MD, FAAP, a member of the American Academy of Pediatrics national committee on coding and nomenclature.