Pediatric Coding Alert

Question: For children with congenital defects, our neurodevelopmental program initially performs assessments that involve multiple providers, ongoing consultation, and prospective management. How should I report the 40- to 90-minute follow-ups that the nurse also performs?

Washington Subscriber Answer: For a child who has an acute or chronic illness and no mental illness, you should report nurse reassessments with 96151 (Health and behavior assessment [e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires], each 15 minutes face-to-face with the patient; re-assessment). Bill one unit for each 15 minutes that the nurse spends with the child.

The health and behavior reassessment code focuses not on mental health but on the biopsychosocial factors important to physical health problems and treatment, CPT Changes: An Insider's View 2002 states. For instance, a child with spina bifida (741.xx) presents to a nurse for reassessment and follow-up treatment. The nurse reviews the child's previous records and compares his current response to health stressors, such as frequent hospitalizations and ongoing physical therapy, to the child's original levels. In addition, the nurse interviews the patient, assesses the original treatment plan's effectiveness, and adjusts the plan accordingly. The reassessment takes 75 minutes.

To report the example, assign one 96151 unit for each 15 face-to-face minutes. In this case, you should bill 96151 x 5.
 
- You Be the Coder and Reader Questions answered by Richard J. Ruthven, CPC, coding compliance specialist at Texas Children's Hospital in Houston; Peggy S. Smith, office manager at Carl E. Smith, MD, FAAP, in Harlan, Ky.; and Sherry Wilkerson (Straub), RHIT, CCS, CCS-P, coding and compliance manager for Esse Health in St. Louis.