Documenting services and understanding the appropriate levels of care in the coding guidelines is especially important in pediatrics, where under-coding for routine visits is a common mistake.
CPT® is confusing and trying to understand new codes is not easy, said Donelle Holle, an RN with more than 38 years of experience in coding and billing. But getting codes right is critical to your practice, she said: A simple coding error, like coding a routine visit as 99213 instead of 99214, can cost a practice thousands of dollars in lost revenue a year.
Holle laid out the 2018 pediatric coding updates for pediatricians, practice administrators, office managers, billers and coders in a recent conference for ProfEdOnDemand, “2018 CPT® & ICD-10 Updates and Review on Leveling of Care.”
Codes of Interest
A number of CPT® codes for 2018 will be of interest to pediatric offices. They include:
- Cardiology codes from 34701 to 34715
- Evaluation and management codes dealing with behavioral health conditions
- Two new flu vaccine codes and one new shingles code
- Several new pulmonology codes
For psychiatric collaborative care management (PCCM):
- 99492: Initial calendar month within an episode of care
- 99493: Subsequent PCCM
- 99494: Initial or subsequent PCCM when visit times are exceeded by 16-30 minutes
Holle notes that for PCCM, the behavior healthcare manager is someone with a master’s or doctorate degree or who is specialized in behavioral health and who is directed by the physician. Services can be in person or not, though they must take place at least once a week.
And for 99484: Care management services for behavioral health conditions, there must be at least 20 minutes of clinical staff time per month that are directed by a physician or qualified health care provider. The sessions must include:
- An initial assessment or follow-up monitoring
- Behavioral healthcare planning
- Treatment facilitating and coordination
- Continuity of care with a designated care team manager
Revised Codes
Revised codes for 2018 include:
- 99217: Discharge observation service
- 99218-99220: Observation service, initial visit
- 99234-99236: Admission and discharge on the same calendar date
- 17250: Chemical cauterization of granulation tissue
The 2018 codes make note of the difference between a “new” and “established” patient. A new patient has not been seen by the provider within the past three years, while an established patient has been seen within the past three years. Holle said the criteria and work effort difference are “huge.”
For night owls, Holle noted the after-hours codes:
- 99050: Services provided in office at times other than regularly scheduled office hours
- 99051: Services provided in office during regularly scheduled evening, weekend or holiday office hours, in addition to basic services
- 99053: Services provided between 10 p.m. and 8 a.m. at a 24-hour facility, in addition to basic services
- 99058: Services provided on an emergency basis in the office that disrupt other scheduled office services, in addition to basic services
How to Not Fear an Audit
Holle said coders and billers should not have to fear an audit—understanding codes and knowing how to use them is good both for coders and their practices. Knowing how to document correctly is key to ensuring your confidence in an audit.
