Pediatric Coding Alert

There are some significant new codes and changes in coding language in CPT 2000 for pediatricians which affect vaccine administration, neonatal intensive care codes, Dermabond, Synagis, vision screening and colposcopy for child abuse. These changes take effect in January, although past experience shows that many insurance companies wait until well into the new year to load them into their systems.

Vaccine Administration

1. Revised code for vaccine administration. The vaccine administration codes issued in 1999 were found faulty immediately. 90471, which is for one vaccine, is fine. But 90472 is for two or more (i.e., whether you give two or four you can only use the CPT 99472 code once), and that, when pediatricians are frequently administering three, four, or even five is not fair. CPT 2000 will redefine the second code to be for each subsequent vaccination. So now, you will be able to bill for each vaccine you administer.

90472 - Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections and/or intranasal or oral administration); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

Neonatal Intensive Care Codes

2. New verbiage in introduction to neonatal intensive care codes. There will not be any new codes, but there will be new verbiage making it clear that these codes are to be used for neonates who are admitted at the age of 30 days or less, and can be used as long as the child qualifies for critical care during this stay. They can not be used for babies who are admitted over the age of 30 days. The pertinent new verbiage is below.

The neonatal critical care codes (99295, 99296, 99297, 99298) are applied to neonates (30 days of age or less) admitted to an intensive care unit. These codes will be applicable as long as the child qualifies for critical care services during this hospital stay. Infants admitted to an intensive care unit older than one month of age would be coded with hourly critical care codes (99291, 99292) if they qualify for critical care services. These neonatal codes are not applied based upon the type of unit (e.g., pediatric or neonatal critical care unit) in which the child receives care nor the type of provider delivering the care.

Using Dermabond

3. New verbiage to allow use of laceration repair codes with Dermabond. There will be a code for wound closure using tissue adhesive (Dermabond) instead of (or in conjunction with) sutures. This is necessary because the laceration repair codes currently contain no verbiage about Dermabond. The pertinent new verbiage is below.

Use the codes in this section to designate wound closure utilizing sutures, staples, or tissue adhesives (e.g., 2-cyanoacrylate), either singly or in combination with each other, or in combination with adhesive strips. Wound closure utilizing adhesive strips as the sole repair material should be coded using the appropriate E/M code.

Coding for Synagis

4. New code for Synagis. The new intramuscular respiratory syncytial virus (RSV) vaccine has replaced RespiGam, but there has been no vaccine code for it. You will no longer need to use the unlisted vaccine code. However, you will still have to find ways to convince payers to pay for the drug, which is about $900 for one dose. (The best recommendations we have heard yet are to (1) get it on the patient's pharmacy benefit, or, failing that, (2) contact the major medical portion of the insurance and simply ask the company to pay for the vaccine. See PCA 3/99.)

90378 - Respiratory syncytial virus immune globulin (RSV-IgIM), for intramuscular use

Vision Screening Code

5. New code for vision screen. There will be a new code for vision screening, which will make it possible for pediatricians to bill for a commonly performed but time-consuming (in pediatrics) procedure. You must be using graduated visual acuity stimuli giving a quantitative estimate of visual acuity.

99173 - Screening test of visual acuity, quantitative, bilateral

The screening test used must employ graduated visual acuity stimuli that allow a quantitative estimate of visual acuity (e.g., Snellen chart). Other identifiable services unrelated to this screening test provided at the same time may be reported, separately (e.g. preventive medicine services.) When acuity is measured as part of a general ophthalmological service or of an WE/M service of the eye, it is a diagnostic examination and not a screening test.

Colposcopy for Child Abuse

6. New colposcopy code for child abuse. There is currently no code for an anal/genital exam using a colposcope for suspected trauma. This is a pediatric code; colposcopies are not generally done in pediatrics except for child abuse.

99170 - Anogenital examination with colposcopic magnification in childhood for suspected trauma (For conscious sedation, use 99141, 99142).