Pediatric Coding Alert

If your payer follows CCI, remember face-to-face outweighs other options.If any of your payers follow Medicare's Correct Coding Initiative (CCI) edits, watch your providers' coding for phone consults. Recent CCI edits include more than 100 code pairs that center on telehealth services, so be sure providers know when they can -- or can't -- separately report these consultations.Steer Clear of Telehealth ReportingThe G codes in HCPCS apply to Medicare carriers, but might have some application for pediatricians whose payers follow Medicare guidelines. CCI 16.2 clarifies that CPT and CMS coding instructions prohibit you from reporting two sets of telehealth consultation codes with many E/M services:G0406-G0408 -- Follow-up inpatient, telehealth consultation ...G0425-G0427 -- Initial inpatient telehealth consultation ...The consultation level (limited, intermediate, or complex) and amount of physician time spent during the consultation distinguish the codes in both groups.Correct approach: Instead of reporting the telehealth code, opt for the appropriate face-to-face E/M service the pediatrician [...]