Pediatric Coding Alert

The new E/M guidelines won't be out for at least a year. They were supposed to be published in CPT 1999, but HCFA put off publication; practices can now use either the 1995 guidelines (published in the current CPT) or the 1997 guidelines (not published in CPT).

The bad news is the new E/M guidelines will include some form of counting. This means that to document each level, physicians will have to count a certain number of clinical activities. The numeric formula, whatever it ends up being, has physicians so up in arms that the American Medical Association (AMA) had said it would not participate in writing them. The good news, however, is that the AMA now realizes that it must have some role in the creation of the new documentation guidelines, or physicians will be frozen out of future involvement. So the new guidelines will bear some resemblance to the 1997 guidelines which do not have to be used, but which can if physicians so desire. Since pediatricians do not work with Medicare, for the most part, its unlikely that they would choose the 1997 guidelines over the 1995 guidelines (the ones which are published in 1998 CPT).

The American Academy of Pediatrics will also be participating in the development of the E/M revisions, says Bela Agrawal, senior health policy analyst in the division of physician payment systems. Many pediatric billers believe that level five office visits are seriously jeopardized by a numeric formula, something that pilot testing which HCFA has agreed to may help reveal. Finally, the revisions wont be out until late 1999 at the very very earliest, says Agrawal.