Pediatric Coding Alert

Surprise: E-visits become mainstream with CPT Category I code

Has the imprecise matching of simple, intermediate or complex to 99371-99373 made you shy away from using these codes? CPT 2008 will offer you a more straightforward method, as well as a new code for another office visit alternative and specific nonphysician counseling codes.

If the AMA CPT panel gives final approval, you can look forward to implementing these CPT changes for Jan. 1. The following is based on general information available. Code specifics could vary on publication. Welcome Your Call Code Selection Getting Easier Top one for pediatrics? "Three new codes for telephone E/M care have been proposed for 2008," said Joel Bradley Jr., MD, FAAP, a member of the AMA CPT Editorial Panel at The Coding Institute's 2007 Pediatric Coding & Reimbursement Conference. "The length of the call will determine which code to pick."

Benefit: You can forget figuring out telephone care complexity. Codes 99371-99373 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals ...) require you to decide if the call is simple/brief, intermediate or complex.
You may also have more guidance on which phone calls you should include as part of an E/M service and which you should separately report. The proposed telephone care codes will have a "global" period of seven days, Bradley says. If you treat the problem in the office within seven days before or after the phone call, you would not bill the telephone care.

Example: A mother calls to report that a sibling has developed the same problem as the other child you recently treated. If the pediatrician talks to the mother, in 2008 you could use a telephone care code based on time, rather than on complexity.

But the big question for practices will remain: Will payment make reporting the new telephone care codes worthwhile? CMS will need to publish RVUs (relative value units) for possible payment of the new codes to move forward, Bradley says. Check with payers about reimbursement. Anticipate Acceptance of E-Visits Another non-face-to-face service that may be coming into its own in 2008 is an "e-visit." Online E/M visits, consultations and Web-visits all fall under the term "e-visit," which is a structured non-urgent consultation between a doctor and an established patient conducted over the Net.

Change: Because e-mail service is no longer considered an "emerging technology" (temporary Category III codes), "there's been a move to make it a Category I code," Bradley says. If the service makes it into CPT 2008, it would replace the 2004-created CPT category III code (0074T, Online E/M service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response [...]