Pediatric Coding Alert

With media coverage of school shootings and violence among children increasing, pediatricians are being called upon more frequently to counsel patients and their families about anger management, violent behavior and guns. These time-intensive visits can be coded in one of six ways.

Choosing a Code

1. Office visit (99212-99215, 99201-99205): If a parent brings a child to the office because of concerns about behavior the teen-ager may be sullen, listening to music with violent lyrics, dressing in gang clothing, performing poorly in school or exhibiting other signs that worry the parent code the visit based on time (99212-99215 for an established patient, 99201-99205 for a new patient). Although you may perform an extensive physical exam and history of present illness, counseling typically predominates.

Base the level on the time indicators in CPT: CPT 99201 (10 minutes), 99202 (20 minutes) 99203 (30 minutes), 99204 (45 minutes), 99205 (60 minutes), 99212 (10
minutes), 99213 (15 minutes), 99214 (25 minutes) and 99215 (40 minutes).

2. Consultation (99241-99245): If another source, such as a school nurse, requests that you see the child for violent behavior, you can bill an office consultation code (99241-99245), says Richard Tuck, MD, FAAP, founding chair of the AAP coding and reimbursement committee. Consultation codes are for new or established patients, and a physician may bill a consultation on his or her own patient.

As with the office visit codes, choose the level based on time, as more than 50 percent of the visit will be spent on counseling. The time indicators in CPT call for 15 minutes for 99241, 30 minutes for 99242, 40 minutes for 99243, 60 minutes for 99244 and 80 minutes for 99245. CPT allots more time per level to consultations than to office visits because consultations include higher relative value units.

Note: You must give a written report to the requesting source physician or school nurse to bill a consultation. For more information on billing consults, see Pediatric Coding Alert, April 2001, page 27.

3. Confirmatory consultation (99271-99275): A consultation does not have to come from a physician, but some payers prefer that it does. If the referral for the visit does not come from a physician, some coders believe confirmatory consultation codes (99271-99275) are more likely to be paid than the consultation codes. If a school thinks theres a problem, for instance, and they refer the child to you, you should use the confirmatory consultation codes, says Donelle Holle, RN, manager of professional fee services for the department of pediatrics, University of Michigan Health System, in Ann Arbor.

One good reason not to bill the confirmatory consultation codes is that CPT has not established times for them. You must choose a level based [...]