Pediatric Coding Alert

More and more patients are getting treated at home instead of in the hospital, and newborns are no exception. Managed care would rather not spend the money on inpatient treatment unless it is absolutely necessary; also, parents would much rather have their new babies at home. However, this does make extra work for the pediatrician, as Julie Sanders, office manager for the Southern Sierra Medical Clinic in Ridgecrest, CA notes. The pediatrician is spending a minimum of 30 minutes per day reviewing follow-up lab results and spending time on the phone with the family, she writes. Please advise as to which code a physician may use to manage the care of a newborn who is receiving phototherapy in the home for hyperbilirubin. We talked to three office managers for an answer.

1. See the patient. Put simply, if the baby comes into your office, you can bill for an office visit. Otherwise, its going to be difficult to get reimbursed for much, says Jeannine Bailey, CMA, practice manager for Londonderry Pediatrics, a four-pediatrician practice in Londonderry, NH. We always have the baby come in from home to see the pediatrician before ordering the home therapy, says Bailey. If the baby left the hospital with high bilirubin, we want to make sure that feeding is going well, she notes. The nurse then makes all the arrangements for the home therapy.

For this office visit, Bailey usually uses CPT 99213 . This one code must cover the costs of any subsequent days of treatment in terms of the pediatricians time, says Bailey. But it doesnt have to be that much time, she notes. We send the baby to the lab on an outpatient basis for the tests, she says. Then when we get the results, which the lab either phones in or we can get off the computer. The pediatrician decides whether the phototherapy should be continued or stopped.

The parent must be called with the results as well as the home health care agency, but the nurse can make these calls, says Bailey. There is some training involved to enable the parents to use the phototherapy equipment, and while the pediatrician goes over some of this during the office visit, the home health agency does most of the training as well as the equipment set-up, says Bailey.

2. Telephone and care plan oversight codes. The telephone call codes dont work, says Tanya Mathews, accounts manager for Newborn Services, a five-neonatologist practice in Columbus, OH. We often supervise phototherapy at different sites, says Mathews. We need to bill for it because the doctor spends a lot of time coordinating with the parents and talking to the nurse on the unit, the accounts [...]