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 won't, however, have to do one thing that you had to with the 2007 team conferences codes: code based on time. The new codes are open-ended, for "30 minutes or more," meaning you will code the conference only once regardless of its length.

Difference: The current codes are for "approximately 30 minutes" and "approximately 60 minutes." This language allows you to capture additional time with prolonged services.

Example: A pediatrician attends an IEP meeting for a hearing-impaired patient without the patient or her family. He spends a total of two hours in the team conference.

In 2007, you would have coded the conference with 99362 for the first 60 minutes of the team conference. For the second hour, you could have also reported prolonged services (+99358, Prolonged services without patient contact).

New way: You will be able to code the conference with only 99367. The single code will capture the entire conference's length. "This is quite a distinction from the previous codes," Rappo says.

Take Advantage of Service's Full Range

Team conferences apply to much more than IEPs. "These are great codes to use that are really beneficial, especially when coordinating care of children with chronic conditions," Rappo says. Open your eyes to the full use of these codes:

• Disorder management: When a pediatrician--or in 2008, a nonphysician professional--meets with a patient's teacher and the school psychologist to discuss the child's developmental and/or behavioral problems, such as ADD/ADHD, you may use team conference codes.

• Chronic conditions: A pediatrician meets for 30 minutes with all care givers for a patient with a g-tube or ventilating tube about feeding issues. Now you would code this based on time with 99361-99362. In 2008, you'll use 99367.

• Abuse: Consider these codes for a team conference or meeting with Child Protective Services, police, or rape crisis counselors, says ChildabuseMD.com's article "Documentation: Coding for Billing." "Document time spent, people present, content of discussion, and plans for the patient," the article says.

Could 99366 Be the Diamond in the Rough?

Don't discount team conference codes due to nonpayment assumptions. Massachusetts insurers including Massachusetts Medicaid do pay these underused codes, Rappo says.

But not all pediatricians have experienced such success. "Insurers have not paid for the old ones," says Ann S. Botash, MD, professor of pediatrics and pediatric department vice chair for educational affairs at the State University of New York Upstate Medical University in Syracuse.

Outlook bright: Payment, however, for 99366 is in the works. Although team conferences are currently non-face-to-face services (patient not present), which Medicare will not cover, in 2008, you might be able to use "Medicare pays them" to get private insurers to pay 99366-99368.

Why: Congress and the American College of Physicians (ACP) are encouraging valuation of new codes that advance the patient-centered medical home. "Medicare should be directed to pay separately for the following CPT/HCPCS codes [including new physician team conference codes] that involve coordinating patient care for which Medicare currently does not make separate payment," according to an ACP statement presented to the U.S. House of Representatives Committee on Ways and Means.

Use Council to Gain Conference Coverage

Showing insurers the cost savings of a patient-centered medical home might convince them to pay for team conferences. "Insurers will only pay if they see the benefit," Rappo says.

Do this: Present a united front. That's how Massachusetts physicians won payment for current team conference codes. "We bring up non-coverage issues through our medical society and pediatric council," which as a whole addresses insurers' code policies, Rappo says.