Pediatric Coding Alert

You'll have 3 new codes for ADHD school meetings, vent mgmt issues and more

Don't have time to attend that Individualized Education Plan (IEP)? Send your nurse. CPT 2008 makes it easier to cover more team conferences--you just have to let your staff attend.

Catch this: In 2008, you'll look at more than time when coding medical team conferences. The AMA deleted the two team conferences codes (99361, Medical conference by a physician with interdisciplinary team of health professionals or representative of community agencies to coordinate activities of patient care [patient not present]; approximately 30 minutes; and 99362, ... approximately 60 minutes). When choosing between the new team conference codes, zoom in on the provider and the patient. Limit MD Conference to Without Family If the conference involves the pediatrician, you'll use 99367 (Medical team conference with interdisciplinary team of healthcare professionals, patient and/or family not present, 30 minutes or more; participation by physician).

"Physicians only get to do a team conference without a patient or family," says Peter Rappo, MD, FAAP, a practicing pediatrician and clinical professor of pediatrics at Harvard Medicine School in Boston. Beware the Rules The non-face-to-face restriction could be problematic, Rappo says. "Parents may want to be at an IEP to make sure the plan is in the child's best interest." If you hold the IEP at the office and the patient and family are present, you should instead report office visit codes (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) using time as the controlling factor, provided the physician spends more than 50 percent of the encounter counseling and/or coordinating care.

Idea: If a patient and/or his family wants to attend an out-of-office IEP, consider having a staff member attend in place of the pediatrician.

Choose Non-MD Code Based on FF or NFF
 
Two new codes will open the door to nonphysician qualified healthcare professionals participating in team conferences. The professional could be almost anybody, such as a respiratory therapist or physical therapist, Rappo says. This seems odd because usually the physician is the team captain and would lead the conference, he says.

Don't overlook: Nonphysician practitioners will have more options. They can code face-to-face or non-face-to-face patient/family team conferences, Rappo says. Here's how:

1. If the patient and/or family is present for the conference, choose 99366 (Medical team conference with interdisciplinary team of healthcare professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified healthcare professional).

2. When the patient and/or family do not attend the meeting, use 99368 (Medical team conference with interdisciplinary team of healthcare professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified healthcare professional). Realize Codes End Add-on Possibility You [...]