Pediatric Coding Alert

More special service specifics may yield greater coverage

Don't be so quick to brush off learning about special service codes for 2006--new and revised codes may make 99050-99060 a moneymaker. 

Because many insurers, such as Blue Cross Blue Shield, don't pay for special services, many coders haven't been using 99050-99060 (Special services, procedures and reports). Companies often wanted additional documentation to describe the special service, recalls Tammy Trench, CPC, accounts receivable technical advisor at Apex Practice Management in Oklahoma City. Even with the added information, payers would deny the charge. "So we stopped using the codes," she says.

The subsection's greater specificity in 2006 may improve your chances for payment. Because the codes contain clearer definitions, the changes may open the door to more coverage, says Tina Landskroener, CCS-P, CPC, senior director of compliance at Quincy Medical Group in Illinois. Payers will have a better understanding of when the codes apply.

"Payment, however, will always come down to the payer," says Jeffrey F. Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance and business affairs at EPG--Children's Healthcare of Atlanta at Egleston. Private insurers may follow Medicare's lead and treat 99050-99060 as bundled in that day's service.

Try this: When a private-payer contract comes up for renewal, try to add special services coverage. "If you show an insurer how much money in-office care saves the company over emergency department care, the payer may decide to cover the codes," says Kim Kieke, CPC, a coding quality specialist at a multispecialty clinic with more than 35 pediatricians in Austin, Texas.

Last bet: If the insurer refuses coverage, include in the contract a statement that says 99050-99060 are non-covered services, Kieke suggests. This will allow you to collect the additional charge from the patient.