Pediatric Coding Alert

Tip: Use time as the key element when reporting counseling encounters

When you discuss problems without the patient present, you can easily capture ethical reimbursement if you employ four easy steps.

Don't let visits in which you see only the parent throw you for a loop. "You should code these encounters the same way you would if the patient were there," says Peter D. Rappo, MD, FAAP, assistant clinical professor of pediatrics at Harvard University School of Medicine in Brockton, Mass.

Here's what experts say you need to know about coding parent-only conferences: 1. Time Is the Dominating Factor  When parents alone present to discuss their child's care with a pediatrician, you can code the encounter based on time. "CPT offers you a very handy way to report these visits," Rappo says.

Here's how: Choose the E/M level based on the time the pediatrician spends talking to the parents. When a physician spends more than 50 percent of an encounter on counseling, CPT states that you can use time as the controlling factor to qualify for a particular level of E/M services, Rappo says.

You may not realize that parent-only discussions count as counseling. "But when a pediatrician discusses a child's developmental, behavioral or school problem, CPT counts the talking as counseling," Rappo says.

Parents may want to meet privately with you for a variety of issues. Often a parent who suspects her adolescent of abusing a substance, such as drugs or alcohol, wants to meet with the pediatrician about her parental rights, says Victoria S. Jackson, administrator at Southern Orange County Pediatric Association with five pediatric offices in Lake Forest, Calif. "Parents want to know whether they can demand a urine screening." If parents suspect that their  teen-ager is sexually active, they may want advice on approaching the topic with their son or daughter.

Because a pediatrician spends 100 percent of parent-only visits on counseling, you can use time to code these encounters. Therefore, you can use the total face-to-face time that the pediatrician spends with the parents to select the E/M services code , such as 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...). 2. Look at the Level's Time Components
 
To choose the appropriate level, you should refer to the office visit's time designation. Each office-visit level contains a typical time that physicians spend on that service. For instance, when a pediatrician performs 99213, he typically spends 15 minutes face-to-face with the patient and/or family.

Here are typical times that CPT indicates [...]