Pediatric Coding Alert

Question: On April 1, the Centers for Medicare and Medicaid Services (CMS) made the next round of Correct Coding Initiative (CCI) edits available. Does it contain any additions, deletions, or revisions that should concern peds coders?

New York Subscriber

Answer: The main change peds coders should be aware of is that CMS has moved 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) and its add-on, +99359 (... each additional 30 minutes ...) from Column 1 to Column 2 in edits with three other codes, including 99463 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date). Prior to April 1, these prolonged E/M codes were bundled into 99463. Now, the reverse is true, and 99463 is bundled into 99358/+99359.

The other change that could possibly impact your practice's reporting affects 99091(Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time). This is now bundled into a number of care management services, including:

• 99484 - Care management services for behavioral health conditions ...
• 99487 - Complex chronic care management services ... 60 minutes of clinical staff time ... per calendar month
• +99489 - ... each additional 30 minutes
• 99490 - Chronic care management services ...
• 99492 - Initial psychiatric collaborative care management, first 70 minutes in the first calendar month ...
• 99493 - Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month ...
• +99494 - ... each additional 30 minutes in a calendar month...
• 99495 - Transitional Care Management Services ... Medical decision making of at least moderate complexity during the service period Face-to-face visit, within 14 calendar days of discharge
• 99496 - Transitional Care Management Services ... Medical decision making of high complexity during the service period Face-to-face visit, within 7 calendar days of discharge
• G0506 - Comprehensive assessment of and care planning for patients requiring chronic care management services ... .

(To download the full list of CCI edits for this quarter, go to https://www.cms.gov/Medicare/Coding/NationalCorrectCo­dInitEd/Version_Update_Changes.html).