Pediatric Coding Alert

Plus: You’ll also find changes to cerumen removal code.

When some payers stopped reimbursing for consultations in 2010, you probably thought you’d never see another of these codes making its debut in a CPT book—but that’s exactly what you’ll find when you crack open CPT 2014. These and several other codes that will impact pediatricians will greet you in CPT 2014, and the following is a sneak peek of the codes that will affect you the most. Stay tuned to the next issue of Pediatric Coding Alert for more on CPT 2014.

Effective Jan. 1, CPT will include four new codes that describe the work of two medical professionals who discuss a patient’s condition via phone or internet, as follows:

99446   Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s       treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review

99447  11-20 minutes of medical consultative discussion and review

99448  21-30 minutes of medical consultative discussion and review

99449  31 minutes or more of medical consultative discussion and review

As in the past, these new codes are consultative in nature, which means you’ll have to provide a written report back to the requesting physician to qualify for the code, as indicated by the phrase “including a verbal and written report” (emphasis added). It isn’t clear yet which insurers will include payment for these codes, since they are consultations, but keep an eye on Pediatric Coding Alert for more on whether these are payable.

Cerumen Removal Now Strictly Unilateral

For those practices who have struggled with the question of how to report cerumen removal when it involves both ears, the answer is now clear that you’ll need to append a bilateral modifier (modifier 50) to 69210. Although the descriptor for this code used to say “one or both ears,” it now specifically states “unilateral.”

In addition, although most payers specifically indicated that practitioners had to use instrumentation when removing impacted cerumen to qualify for 69210, CPT now follows that lead and puts it right in the code description, with the full descriptor now stating, “Removal of impacted cerumen requiring instrumentation, unilateral.” Therefore, using ear lavage, water pik or ear washings will not qualify for 69210 because they don’t qualify as instrumentation (instead, items like forceps or wax curettes are considered instrumentation).