Pediatric Coding Alert

Although the latest version of the fourth-quarter Correct Coding Initiative (CCI) encompasses the largest number of edits since version 6.3, very few affect pediatric practices. Version 8.3, effective Oct. 1-Dec. 31. 2002, contains nearly 50,000 additions and only five deletions. "Despite the amount of edits, pediatricians don't really need to worry about this version," says Richard Tuck, MD, a member of the American Academy of Pediatrics national committee on coding and nomenclature (COCN). Injection Procedures Bundled The vast majority of new edits in version 8.3 of CCI involve the inclusion of about one dozen injection services to other, more extensive procedures. Hundreds of procedures, including debridement 11000, 11010-11044; biopsy 20200-20206; repair 12001-13160; and intubation 31500, now include:

CPT 36000 * - Introduction of needle or intracatheter, vein

36410* - Venipuncture, child over age 3 years or adult, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes. Not to be used for routine venipuncture

90780 - Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour. All of the above edits include a superscript of 1, meaning that both procedures may be reported if they are performed at separate anatomic sites and modifier -59 (Distinct procedural service) is appended to the component code. The edits are basically stating that the injection is included in the service unless it is unrelated to the procedure. In addition, office visit codes 99201-99215, office consultations 99241-99245, confirmatory consultations 99271-99275, and emergency department visits 99281-99285 cannot be billed separately when the observation codes 99218-99220 and 99234-99236 are also billed. "These would be incorporated in a higher level of observation code based on including the work from the outpatient visit in the inpatient observation code," Tuck says. "Coding convention has traditionally allowed the reporting of one E/M service per day, so these edits have little consequence."