Neurology & Pain Management Coding Alert

CPT 2003 brings numerous text additions and code revisions but no major or unexpected changes for neurology practices. Primarily, modifications for the new year attempt to clarify and formalize already established coding principles. New Codes Added to E/M Services E/M services undergo several revisions for 2003. Specifically, CPT now further differentiates critical care according to patient age. New codes 99293 (Initial pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child) and 99294 (Subsequent pediatric critical care) describe critical care for patients 31 days to 2 years of age, while previously established 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) continue to describe critical care for patients older than 24 months. The same definition of critical care ("A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient's condition") applies regardless of patient age and does not change for 2003.

According to AMA's CPT Changes 2003: An Insider's View, 99291/99292 reflect "the additional work related to the age of these young patients due to small size, previous therapy, and limited mechanisms of physiological compensation."

In addition, CPT 2003 revises neonatal intensive care codes 99295 and 99296 to reflect the availability of 99293 and 99294. The neonate codes now specify initial/subsequent neonatal critical care, per day, for the evaluation and management of a critically ill neonate, "30 days of age or less." According to revised guidelines, 99295 and 99296, "may be reported only once per day, per patient. Once the neonate is no longer considered to be critically ill, the Intensive Low Birth Weight Services codes for those with present body weight of less than 2500 grams (99298, 99299) or the codes for Subsequent Hospital Care (99231-99233) for those with present body weight over 2500 grams should be utilized." Note: Low birth weight service code 99299 is new for 2003 and describes "Subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant (present body weight of 1500-2500 grams)." As in previous years, 99298 describes the same services for a neonate of less than 1,500 grams. 'Miscellaneous Services' Codes May Not Pay CPT 2003 also introduces two "Miscellaneous Services" codes, although Medicare probably won't reimburse for them, presumes Douglas Jorgensen, DO, CPC, a practicing physician in Manchester, Maine, and chairman of the Osteopathic Medical Economics Committee:

99026 Hospital mandated on-call service; in-hospital, each hour 99027 [...]