Pediatric Coding Alert

The Correct Coding Initiative, version 8.1, includes some new bundling edits of interest to pediatricians caring for patients with kidney conditions. All of the edits involve E/M codes 99201-99456. Code 90940 Hemodialysis access flow study to determine blood flow in grafts and arteriovenous fistulae by an indicator dilution method, hook-up; measurement and disconnection) has been bundled into all E/M codes because of a code revision for 2002. Also notable in version 8.1, codes CPT 90471 Immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]) and 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) are now mutually exclusive. However, notes Linda Walsh, senior health policy analyst with the American Academy of Pediatricians division of healthcare finance and practice, the bundle allows an override with a modifier.

Other new code edits that affect pediatricians include the following:

Codes 99217-99220 (Hospital observation services) now include 90918-90920 (End stage renal disease [ESRD] related services per full month). These codes apply only to pediatric patients (up to age 20). Unbundling is allowed under proper circumstances with modifier -59 Distinct procedural service). Codes 99271-99275 (Confirmatory consultations for new or established patients) now include new glaucoma screening codes G0117 and G0118. Unbundling is never allowed. Codes 99295-99298 (Initial neonatal intensive care) now include 90918-90920. Unbundling is allowed with modifier -59. Codes 99321-99350 (Domiciliary, rest home, custodial care, or home services) include G0179 and G0180 (Physician certification for Medicare-covered services provided by home health agency). Unbundling is allowed with modifier -59. Codes 99455 and 99456 (Work related or medical disability evaluation services) now include 97532 Development of cognitive skills to improve attention, memory, problem solving, [includes compensatory training], direct [one-on-one] patient contact by the provider, each 15 minutes) and 97533 (Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct [one-on-one] patient contact by the provider, each 15 minutes).

Codes 99201-99456 are now bundled with G0121 (Colorectal cancer screening).

Prolonged services without direct patient contact (99358), case management services (99361-99373), care plan oversight services (99374-99380), preventive medicine services (99381-99397), counseling and/or risk factor reduction intervention (99401-99429), newborn care (99431-99440), and basic life and/or disability evaluation services (99450) include G0121.