Coding Changes for 2002

Abstract

Although there are few changes in Current Procedural Terminology (CPT) 2002 that affect pediatrics, it is important for the pediatrician and staff to look at these new and revised codes (as well as the new and revised International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] codes that went into effect October 1, 2001), review their encounter form, and add the changes that will affect their practice. Although the CPT codes went into effect January 1, 2002, many carriers will not begin using the new codes until April 1. It is a good idea to ask carriers when they will begin reimbursing the new codes, which codes they will recognize, and how much they will reimburse.American Academy of Pediatrics (AAP) members can submit ideas for new or revised codes to the Division of Health Care Finance and Practice at 800/433-9016, ext 7931. The AAP Committee on Coding and Reimbursement can help members if they are interested in submitting a proposal to the American Medical Association (AMA) for a new or revised CPT code. The CPT Editorial Panel ultimately decides if the new code proposal will pass.The AAP created 2 new codes for physician presence during patient transport. The patient transport codes (99289–99290) are used to report the physical attendance and direct face-to-face care by a physician during the interfacility transport of a critically ill or critically injured patient. Face-to-face care begins when the physician assumes primary responsibility for the patient at the referring hospital or facility, and ends when the receiving hospital or facility accepts responsibility for the patient’s care. Only the physician face-to-face time should be reported. Patient transport of less than 30 minutes of face-to-face physician care should not be reported with these codes. The time spent reporting separately identifiable services or procedures should not be included in the face-to-face time reported by codes 99289 and 99290.The emergency department codes (99281–99285), initial hospital care codes (99221–99223), hourly critical care codes (99291–99292), and initial date neonatal intensive care code (99295) are reported only after the patient has been admitted to the emergency department, the inpatient floor, or the critical care unit of the receiving facility.For the vaccine administration codes, there are 2 new codes (90473–90474) and 1 revision (90471). In anticipation of the future release of intranasal vaccines and the continued, although rare, use of oral vaccines, code 90471 was revised and new codes 90473 and 90474 were added to differentiate the work involved in administering vaccines by injectable versus oral or intranasal routes. Code 90471 has been revised to indicate the following:Use 90472 in conjunction with 90471.The 2 new codes are the following:Use 90474 in conjunction with code 90473.Code 90732 was revised to reflect the recommendation of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the AAP, which is that the 23-valent pneumococcal polysaccharide vaccine be indicated for children at high risk who are 2 years or older.For a list of current vaccine codes, see Table 1.The microbiology guidelines have been revised to include the instruction, “When separate assays are performed for different species or strains of organisms, each assay should be reported separately.” This will help ensure accurate reporting of many of the agents within this section of CPT.These were added to describe visually read immunoassays for specific infectious diseases antigens using the direct optical observation method.The new health and behavior assessment codes (96150–96155) are not intended to be used by physicians. They are for use by clinical social workers, psychologists, and others who traditionally cannot report evaluation and management (E/M) codes. Physicians must use the E/M codes for these services based on counseling and coordination of care. The new codes are used when assessing or treating psychosocial factors affecting patients who suffer from an established medical illness, not for those with mental health disorders.A health and behavior assessment may include a health-focused clinical interview, behavioral observations, psychophysiologic monitoring, use of health-oriented questionnaires, and an assessment of data interpretation. Elements of a health and behavior intervention may include cognitive, behavioral, social, and psychophysiologic procedures that are designed to improve the patient’s health, ameliorate specific disease-related problems, and improve overall well-being.The new codes for home visits (99500–99569) are to be used by nonphysicians. Pediatricians who perform home visits should report 99341–99350. The new codes are to be used for services in a patient’s residence, which may include assisted-living apartments, group homes, nontraditional private homes, custodial care facilities, or schools.CPT codes 99551–99569 describe infusion therapy performed by nonphysician health care professionals in the patient’s residence. The codes include all the necessary solutions, equipment, and supplies, including drugs, needed to deliver a therapy in a 24-hour period.All drugs are reported separately with the appropriate Health Care Financing Administration Common Procedure Coding System (HCPCS) code(s).