Pediatric Coding Alert

Question:

Virginia Subscriber

CPT^® introduced code Category II code 1005F (Asthma symptoms evaluated [includes physician documentation of numeric frequency of symptoms or patient completion of an asthma assessment tool/survey/questionnaire) in 2006, but you won't collect for it.

The code is marked with the status code "M," which means, "measurement codes, used for reporting purposes only" according to the Medicare Physician Fee Schedule, and is assigned 0 relative value units. Most private payers follow this lead and will also not reimburse for this code.

Background: Category II codes help better describe E/Ms and can correlate a patient's disease to the treatment rendered. Although these codes are not required, the AMA's intent is to help data mining by coding certain services and/or test results found to be contributing factors to positive health outcomes and quality patient care. However, Category II codes may not be used as a substitute for Category I codes, asserts CPT^® 2011. Therefore, if you choose to report a Category II code, it should be used as a secondary code and not as a primary code.

You should check with your payer to determine whether this service is covered. Cigna, for instance, marks this service as "experimental/investigational/not covered" in its policy (http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0439_coveragepositioncriteria_exhaled_nitric_oxide_monitoring.pdf), but if your payer will reimburse for it, you should get the coverage decision in writing, along with advice on how to code the service.