Pediatric Coding Alert

Question: A patient presented to our office with complications from a bee sting. Our pediatrician administered the appropriate medications for the reaction and stayed with the patient for an hour until he was stable. How should I code for this office visit? Can I report the medications separately?

Tennessee Subscriber

Answer: To report the physician's services, you could use an E/M code, such as 99214 (Office or other outpatient visit for the E/M of an established patient ...). Also, you can bill a J code, such as J0170 (Injection, adrenaline, epinephrine, up to 1 ml ampule), to be reimbursed for the medication.

In addition, you may assign codes +99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service [e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting]; first hour [list separately in addition to code for office or other outpatient evaluation and management service]) and +99355 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]).

But before using these codes, you should know how to calculate your time - which might be harder than you think. CPT assigns each office or other outpatient E/M code (99201-99215) a typical time for completing the service. Because the physician stayed with the patient for an hour and 99214 represents a 25-minute service, you should bill for the additional 35 minutes by reporting one unit of 99354.

You can only count minutes that the physician spent face-to-face with the patient toward 99354. If the pediatrician leaves the room and returns occasionally to check on the bee-sting patient, you can add up all of his face-to-face time and count that toward your prolonged service minutes.

If the patient's bee sting leaves him critically ill, and his condition meets the criteria for critical care, you can consider reporting the critical care codes (such as 99291 for the first 30-74 minutes).