Pediatric Coding Alert

Compliance with new AMA recommendations doesn't necessarily equate to more pay, experts say Pediatricians are the latest group charged with trying to prevent childhood obesity's spread. Our experts reveal the CPT codes you should use for this work directive. Do Address These Habits Before you code for the American Medical Association's (AMA) newly recommended dietary childhood assessments, get up-to-speed on the mandate's details. All children should "receive at least an annual assessment of their weight, dietary habits and physical activity levels," according to the article, "Expert Panel Gives Very Heavy Children a New Label -- Obese," in the July 9, 2007, issue of American Medical News published by the AMA. The assessment should address problematic issues, such as frequent restaurant dining, drinking large amounts of sweetened beverages and excessive screen viewing time. The article calls for additional labs in problem patients. If the pediatrician diagnoses the child as overweight, staff should measure the patient's blood pressure and pulse and order lipid studies. The physician should also test obese children's liver and kidney functions. Should you classify these assessments as preventive medicine counseling, preventive medicine services or sick visits? Experts walk you through the coding do's and don't of these latest recommendations. Don't Use 99401-99404 for Normal Assessment Question: Should you account for this weight-related work by using 99401 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes) in addition to the well checkup code? Answer: No. This code combination is incorrect for one simple reason. "CPT categorically does not allow you to report counseling and/or risk factor reduction intervention codes at the same encounter as a preventive medicine service," says Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare in Zanesville, Ohio. Pediatricians must provide 99401-99404 "at a separate encounter for the purpose of promoting health and preventing illness or injury," stipulates the AMA in CPT's counseling and/or risk factor reduction intervention introductory notes. The counseling and/or risk factor reduction intervention code family describes counseling in 15-minute increments. When a pediatrician provides preventive medicine counseling at a preventive medicine service, you should report only the preventive medicine service (99381-99385 for new patients and 99391-99395 for established patients). Preventive medicine services include counseling/anticipatory guidance and risk factor reduction provided at the same encounter, according to-CPT's preventive medicine services introductory notes. Not being able to charge 99401 with 99381-99385 or 99391-99395 probably won't hit your pocketbook. "Most plans consider 99401 a non-covered service," says Nancy Reading RN, BS, CPC, director of education for the American Academy of Professional Coders in Salt Lake City. "I would not bank on seeing extra revenue for this [code]." Good news: "Some payers, such as Ohio Medicaid, may cover [...]