Pediatric Coding Alert

Often, pediatricians must discuss a patients care via telephone with other healthcare providers. Depending on the situation, this service may be reported using one of three kinds of codes.

Care Plan Oversight Codes

Care plan oversight codes (99374-99375 and 99377-99378) cover many services: development or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, and communication. CPT explicitly allows physicians to claim these codes for telephone calls for assessment or care decision with other healthcare or nonphysician professionals involved in a patients care, integration of new information into the medical treatment plan or adjustments of medical therapy. To bill these services, add the total minutes per month spent discussing a patient and choose the correct code based on time.

If the telephone conversation refers to a patient under the care of a home health agency, 99374 applies for 15-29 minutes per month. Code 99375 should be reported for 30 or more minutes per month. Track every minute spent discussing the childs care, and support the claim with documentation.

As an example, a child might be a high-risk graduate of the neonatal intensive care unit, on home oxygen or a home ventilator. The pediatricians time discussing the case with the home health agency could easily add up to more than 30 minutes in a month (99375).

Another, more common example is the newborn on home phototherapy. This therapy, however, often lasts just a few days, and telephone time can only be billed if it totals 15 or more minutes per month.

For a child in hospice care, report 99377 for 15-29 minutes and CPT 99378 for 30 minutes or more.

Note: Only one physician is allowed to report care plan oversight codes per patient during a given time.

Telephone Call Codes: 99371-99373

Many pediatricians use telephone call codes to bill for conversations with parents or patients, but they dont realize they can also access these codes for time spent talking to other healthcare providers.

Report 99371 (telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionals ...) for a simple or brief discussion, 99372 for an intermediate-level discussion and 99373 for a complex or lengthy discussion. According to CPT, these codes apply whether the physician talks to a physician, nurse, pharmacist, nutritionist, physical therapist or any other healthcare provider who is helping to care for the patient.

Code 99371 might be appropriate, for example, for a child with an unusual rash that the pediatrician wants to discuss with the dermatologist. It is also used when briefly discussing lab reports, clarifying pervious instructions or adjusting current [...]