Pediatric Coding Alert

Question: A pediatrician reviews labs over the phone with a patient’s parent and provides high-cholesterol counseling. May I report the non-face-to-face coordination of care with the new code for home care plan oversight service?


North Carolina Subscriber


Answer: The home care plan oversight codes (99339-99340, Individual physician supervision of a patient [patient not present] in home … requiring complex and multidisciplinary care modalities ...) are for children with special healthcare needs and chronic medical conditions. A child with high cholesterol does not require the services this category involves. 

You should use the new codes to describe the work a pediatrician provides on a monthly basis while performing frequent complex supervision services to a patient in a home, domiciliary or rest home including:

• regular physician development and/or revision of care plans

• review of subsequent reports of patient status

• review of related laboratory and other studies

• communication (including telephone calls) for purposes of assessment or care decisions with healthcare professional(s), family member(s), surrogate decision-maker(s) (e.g., legal guardians), and/or key caregiver(s) involved in a patient’s care

• integration of new information into the medical treatment plan and/or adjustment of medical therapy.

CPT Codes Changes 2006: An Insider’s View, published by the AMA, uses an individual with Down’s syndrome and a patient with Alzheimer’s disease as clinical examples of these codes. CPO services reported as 99339 (… 15-29 minutes) for the Down’s syndrome patient include:

• review of audiology/endocrine consultation reports
• telephone call to the audiologist
• completion of medical forms
• telephone call to the family regarding patient’s habits after new treatment and to the psychiatric nurse practitioner
• review of endocrine recommendations with subsequent telephone calls to family and pharmacy to change prescription’s dose.

An isolated telephone call to review lab results and discuss lifestyle modification with a patient’s parent, as your example involves, does not qualify as “complex and multidisciplinary care modalities.” When a pediatrician provides very low-intensity or infrequent supervision services, CPT directs you to include the work in the pre- and postencounter work for office/outpatient visit codes (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient …). (See CPT’s care plan oversight services’ [99374-99380] introductory notes, which apply to 99339-99340.)

Alternative: You could instead report the work using telephone call codes (99371-99373, Telephone call by a physician to patient …). Because the call involves initiating therapy, the work would probably qualify as an intermediate-level telephone call (99372, … intermediate [e.g., to provide advice to an established patient on a new problem, to initiate therapy that can be handled by telephone, to discuss test results in detail, to coordinate medical management of a new problem in an established patient, to discuss and evaluate new information and detail, or to initiate new plan of care]).

Problem: Many insurers do not pay for 99371-99373. You could instead document the work in the related E/M service, which would increase the level of decision-making (for instance, from low complexity to moderate) associated with the day’s code and may ultimately result in a higher-level visit (such as 99213 to 99214).