Pediatric Coding Alert

Question: My pediatrician spends two and a half hours attending a hearing-impaired patient's individualized education program (IEP). Should I use a CPT code for his participation and time?

Arizona Subscriber

Answer: For your pediatrician's first hour in the IEP conference, you should report 99362 (Medical conference by a physician with interdisciplinary team of health professionals or representatives of community agencies to coordinate activities of patient care [patient not present]; approximately 60 minutes). You should also code for the additional hour and a half with indirect prolonged services. Use +CPT 99358 (Prolonged evaluation and management service before and/or after direct [face-to-face] patient care [e.g., review of extensive records and tests, communication with other professionals and/or the patient/family]; first hour [list separately in addition to code(s) for other physician service(s) and/or inpatient or outpatient evaluation and management service]) for the first additional hour past that included in 99362, and +99359 (... each additional 30 minutes ...) for the additional half-hour.

Remember to count only your pediatrician's participation time, not travel time. In summary, complete coding for the scenario is 99362, +99358 and +99359.