Pulmonology Coding Alert

Commit these bundled pediatric codes to memory -- and know when adult care codes may apply.

If you're like many others, you're in a tizzy as you work to update your coding skills with the CPT 2009 revisions. Don't fall behind -- instead, use this to-the-point summary for the changes that affect your office.

1: Use New Daily Pediatric Critical Care Codes

Medical offices that treat pulmonary defects in neonatal and pediatric cases will experience the greatest amount of changes with the debut of CPT 2009. Here's what you need to know:

Older patients: Report care for pediatric patients six years of age and older with the adult critical care codes: 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and 99292 ( each additional 30 minutes [List separately in addition to code for primary service]).

You'll also use hourly critical care codes for additional critical care services that other specialties provide other than the physician directing the inpatient care or in an outpatient environment, such as an emergency department. These services can be billed with the adult critical care codes 99291 and 99292, notes Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.

Example: A 3-year-old critically ill child is admitted to the intensive care unit with pneumonia and respiratory failure. The pediatric critical care specialist would code 99475 for the initial day of critical care and 99476 for critical care rendered on subsequent days.-If a pediatric infectious disease physician rendered an hour of critical care on either day, that physician would code 99291 for the critical care rendered, explains Plummer.

Stumper: Which procedures can you bill for in addition to daily critical care codes? Neonatal and pediatric intensive care procedures that are not bundled are: bronchoscopy (31622), thoracentesis (32421-32422),-chest tube insertions (32551), central venous line placement, and CPR-(92950), shares Plummer.

Last but not least, pulmonology coders will need to stay alert to the renumbering of drug infusion codes in CPT 2009. Here's your quick reference guide:

Does your physician conduct sleep studies? Sleep physicians have a new code to report with the inauguration of CPT 2009: actigraphy, 95803 (Actigraphy testing, recording, analysis, interpretation, and report [minimum of 72 hours to 14 consecutive days of recording]). Actigraphy provides information involving circadian rhythms with a portable device that records movement over extended periods.

Details: CPT 2009 instructs you to not report 95803 more than once in any 14-day period. Also, do not report this code in conjunction with 95806-95811 (overnight sleep testing polysomnography codes). Report the actigraphy code with modifier 52 (Reduced services) if there were less than six hours of recording or in other cases of reduced services as appropriate. Remember to use code 95806 for unattended sleep studies.