Pediatric Coding Alert

Outlying hospitals: Make sure you add 94610 to your encounter sheet

Thanks to CPT 2007, you'll soon have two physician- specific codes to describe the initial work and periodic interpretation involved in pediatric home apnea monitoring.

The pulmonary subsection of CPT's medicine section gets a major overhaul with a split into two sub-subsections for "ventilator management" and "other procedures."

New pulmonary codes will be added for home apnea monitoring, ventilator management and surfactant administration. Here are the major pediatric-impacting changes in the pulmonary subsection that you can expect, which are discussed in-depth on the corresponding pages noted below (changes 1-3 reflect the circumcision changes that appear on pages 90-91):

Change 4: Although CPT 2007 will create four home apnea monitoring codes, only two of these codes apply to physicians, says Jill M. Young, CPC-EDS, president of Young Medical Consulting LLC in East Lansing, Mich. "Home health agencies (HHAs) will use the other two codes, which involve no physician work."

New code for initial set-up: When you first decide that a patient requires home monitoring, assign 94774. The code encompasses five services. According to CPT Changes: An Insider's View 2007, the physician:

• orders home monitoring
• chooses the monitor limits
• arranges for a home care provider to meet with the parents
• interprets data supplied by the HHA monthly or after any significant home apnea episode
• prepares a report. New code for periodic review: From the HHA, the pediatrician will periodically receive downloaded information in hard copy or CD form, which he interprets and issues a report on. The report includes recommendations on continuing or discontinuing the monitoring. Code 94777 describes the "physician review, interpretation and preparation of report only."

Keep in mind: Don't interpret 94774 (Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; includes monitor attachment, download of data, physician review, interpretation, and preparation of a report) and 94777 to mean the pediatrician has to relay the information contained in the report. The physician could "send the report back to the primary-care provider for him to discuss with the patient," Young says. Alternatively, the interpreting physician (who is taking care of the patient) could speak with the family. Follow 2 Rules When Coding Vent Mgt CPO Change 5: CPT 2007 will also provide you with a way to code home ventilator management.

New monthly CPO code: For each month of 30 minutes or more of home ventilator management care plan oversight (CPO), you will be able to report 94005, which includes:

• review of status
• review of laboratories and other studies
• revision of orders and respiratory care plan (as appropriate). When using 94005 (Home ventilator management care plan oversight of a patient [patient not present] in home, domiciliary or [...]