Pediatric Coding Alert

AMA offers preliminary peek at proposed 2013 codes.

This year isn't even halfway over, but the CPT Editorial Committee has been reading your mind and knows which codes you're hoping to see in 2013. With the recently-posted online publication of the Committee's February meeting notes, you can see which code changes were proposed for 2013 that may apply to your pediatric practice.

Keep in mind: Even though the proposed changes have been posted online, there is not yet a guarantee that these changes will be instituted in CPT 2013. As the Editorial notes indicate, "Codes are not assigned, nor exact wording finalized, until just prior to publication."

Among the new proposals, you'll find that the CPT Editorial Committee is considering revisions to the neonatal and pediatric critical care guidelines to account for the intensive care physician's work "receiving a patient in transfer from a physician from another group who has been providing hospital services to a patient at a lower level of care, either normal newborn, routine hospital, or intensive."

Rewind: For 2012, CPT changed the introductory language preceding code 99477 to clarify that if a patient was in a lower level of care but gets sicker and is transferred to intensive care, the transferring physician reports critical care or intensive care, while the receiving physician reports subsequent inpatient neonatal or pediatric critical care (99469, 99472).

It now appears that CPT 2013 may further delineate the work required by the receiving intensivist who takes over care of a patient who was previously in a lower level of care in the hospital (such as a normal newborn).

Observation Care to See Update

You might recall that one of the big changes to CPT 2012 was the addition of typical times to the subsequent observation care codes 99224-99226, which allow physicians to code based on time when seeing patients who are treated in the observation unit. However, many coders considered it a glaring oversight that codes 99234-99236 (Observation care, including admission and discharge on the same date) did not have typical times associated with them.

The CPT Editorial Panel's notes indicate that CPT 2013 may include revisions to assign typical times to these codes, although it isn't yet clear what those time guidelines will be.

Vaccine Codes Might Be Linked to E/M Combos

Ask any pediatric coder what the most useful revisions to vaccine coding would be, and many will request a list of applicable E/M codes that they can report with vaccines. This wish might become reality in 2013, based on the following request, which the CPT Editorial Committee accepted in the proposal:

"Revisions to the CPT guidelines in the Medicine/Vaccine/Toxoid Administration subsection to include a specific listing of applicable evaluation and management CPT codes."

Such a listing would eliminate confusion about which codes can and cannot be reported along with vaccine administration codes.

CPT may also list the applicable E/M codes that go along with the Medicine/Education/Training Patient Self-Management codes to make your claims submissions easier.

Vaccine Codes May See Overhaul

As vaccine technology evolves, so do CPT codes for these services, and pediatric coders are familiar with the fact that vaccine codes often change from one year to the next. 2013 will be no different if the proposals that the Committee approved are eventually finalized. Among the changes you'll find the following:

• Revision of influenza virus vaccines 90655-90658 to include the term "trivalent" so they'll be distinguished from developing quadrivalent flu vaccines
• Inclusion of a new code in the 906xx range for a new intranasal quadrivalent influenza vaccine, with a corresponding revision to code 90660 (Influenza virus vaccine, live, for intranasal use) to reflect its nature as a trivalent vaccine
• Introduction of a new code in the 906xx series to describe an adjuvant influenza vaccine
• Deletion of tetanus and diphtheria code 90718 since the preservative-free code 90714 accurately describes all existing vaccine products in this category
• Creation of a new code in the 9074x series to describe an adult two-dose Hepatitis B vaccine; the existing code 90746 would be revised to specify that it should be used for the three-dose product formula

Look for Pediatric Polysomnography Code

Sleep studies can be important diagnostic tools in both the general patient population and the pediatric community, but thus far, CPT has not included codes specific to young patients. The proposal for 2013 intends to change that, with the Editorial Committee's contingent approval of new codes in the 958xx range to describe pediatric polysomnography for children age six and younger.

Consequently, CPT will revise existing polysomnography code 95808 to include the words "any age," and will change codes 95810-95811 to include the age restriction "age six years or older."

Food Allergy Testing Could See New Codes in 2013

Currently, if your pediatrician performs an ingestion challenge test for food allergens, you have to report 95075 (Ingestion challenge test [sequential and incremental ingestion of test items, eg, food, drug, or other substance such as metabisulfite). However, the CPT Editorial Committee may change that next year, with a proposal to introduce separate codes to differentiate food allergy testing from other ingestible allergens.

To read the complete summary of the Committee meeting, visit http://www.ama-assn.org/resources/doc/cpt/summary-of-panel-actions-feb2012.pdf.