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How do you define age?

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Milwaukee WI
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What does “through age x” or “older than x” mean?

I would argue that, strictly interpreting it from the perspective of accurate use of the English words “through" and "older,” that this would cover the person up to the date of the next milestone birth date. So, if it was “through age 5” or “older than 5” it would cover the child until the child’s 6th birthday (but not on the day of the 6th birthday).

However, when I first started coding, I was told repeatedly that the accepted coding practice was that “through age x” or “older than x” meant through the date of that milestone but not the day after. So, with the same example “through age 5” would cover a child on the day of his/her 5th birthday, but not the day after (because the child would now be 5 years and 1 day old …or, “older” than 5). I didn't much like this interpretation, but at least we could consistently apply it. UNTIL now ...

There are new Pediatric Critical Care codes. All page numbers refer to the 2009 CPT Professional edition:

Pg 18, right column, mid page in green is new verbiage wherein several times the phrase “29 days through 71 months of age” is used.

Pg 34, left column, second from bottom paragraph, 3d line we have “29 days of postnatal age through 5 years of age...” Same paragraph at the end we have “child older than 5 years of age...”

Pg 34, right column, last paragraph, 2d line references “patients less than 5 years of age…”

Pg 35, left column, 2d paragraph states “Critical care services to a pediatric patient 6 years of age or older….”

Pg 35, left column we have the actual new codes:
99471 … “child, 29 days through 24 months of age”
99472 … “child, 29 days through 24 months of age”
99475 … “child, 2 through 5 years of age”
99476 … “child, 2 through 5 years of age


So, which is it? If you use the English interpretation of “through” on Page 18 they are saying that the child is covered until s/he turns 72 months (6 years old). BUT Accepted Coding Practice re coding is the child would be covered until the date s/he turned 71 months old.

Using “English” on page 34 child would be covered until s/he turned 6. Using the accepted coding practice, the child would be covered only until the date of the 5th birthday, but not the day after.

Then we have on page 34 the last paragraph the statement about "patients less than 5 years of age" which is clearly stated, but conflicts with other guidance.

Page 35 paragraph with “patient 6 years of age or older,” seems clear by both English and accepted coding practice, but in conflict with other statements.

Page 35 code descriptions have dual interpretations again …
99471-72 by English standard would cover the child until the child turned 25 months of age. (Which would overlap 99475-76 by 1 month.) By accepted coding practice, the child would be covered only until the date s/he turned 24 months. (Overlapping 99475-76 by only 1 day)

99475-76 by English standard would cover the child until s/he turned 6 years old; accepted coding practice would end coverage on the date after the child’s 5th birthday. (Leaving a gap in coverage until you would use the 99291-92 codes for children "age 6 and older.")

Clear as mud …

I THINK I know what they actually mean, but AMA should define the terms or use a different way of calculating age (days of life is pretty clear).

F Tessa Bartels, CPC, CPC-E/M
 
Last edited:

pamtienter

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NAB Member
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I've never heard of the "coding" definitions you mention. That sounds too complicated to me. Where do those come from? I am not familiar with them and have been coding quite a while. Coders I have worked with and I have used the "English" definition so if it says "older than 5" then it would be from the 6th birthday on since then they are no longer 5 and are older. Why would 5 years and 1 day be older than 5? They are still 5. Wouldn't it make sense to take it literally?
 
Messages
114
Location
Madison Area Chapter in Madison WI
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What does “through age x” or “older than x” mean?

I would argue that, strictly interpreting it from the perspective of accurate use of the English words “through" and "older,” that this would cover the person up to the date of the next milestone birth date. So, if it was “through age 5” or “older than 5” it would cover the child until the child's 6th birthday (but not on the day of the 6th birthday).

However, when I first started coding, I was told repeatedly that the accepted coding practice was that “through age x” or “older than x” meant through the date of that milestone but not the day after. So, with the same example “through age 5” would cover a child on the day of his/her 5th birthday, but not the day after (because the child would now be 5 years and 1 day old …or, “older” than 5). I didn't much like this interpretation, but at least we could consistently apply it. UNTIL now ...

There are new Pediatric Critical Care codes. All page numbers refer to the 2009 CPT Professional edition:

Pg 18, right column, mid page in green is new verbiage wherein several times the phrase “29 days through 71 months of age” is used.

Pg 34, left column, second from bottom paragraph, 3d line we have “29 days of postnatal age through 5 years of age...” Same paragraph at the end we have “child older than 5 years of age...”

Pg 34, right column, last paragraph, 2d line references “patients less than 5 years of age…”

Pg 35, left column, 2d paragraph states “Critical care services to a pediatric patient 6 years of age or older….”

Pg 35, left column we have the actual new codes:
99471 … “child, 29 days through 24 months of age”
99472 … “child, 29 days through 24 months of age”
99475 … “child, 2 through 5 years of age”
99476 … “child, 2 through 5 years of age


So, which is it? If you use the English interpretation of “through” on Page 18 they are saying that the child is covered until s/he turns 72 months (6 years old). BUT Accepted Coding Practice re coding is the child would be covered until the date s/he turned 71 months old.

Using “English” on page 34 child would be covered until s/he turned 6. Using the accepted coding practice, the child would be covered only until the date of the 5th birthday, but not the day after.

Then we have on page 34 the last paragraph the statement about "patients less than 5 years of age" which is clearly stated, but conflicts with other guidance.

Page 35 paragraph with “patient 6 years of age or older,” seems clear by both English and accepted coding practice, but in conflict with other statements.

Page 35 code descriptions have dual interpretations again …
99471-72 by English standard would cover the child until the child turned 25 months of age. (Which would overlap 99475-76 by 1 month.) By accepted coding practice, the child would be covered only until the date s/he turned 24 months. (Overlapping 99475-76 by only 1 day)

99475-76 by English standard would cover the child until s/he turned 6 years old; accepted coding practice would end coverage on the date after the child's 5th birthday. (Leaving a gap in coverage until you would use the 99291-92 codes for children "age 6 and older.")

Clear as mud …

I THINK I know what they actually mean, but AMA should define the terms or use a different way of calculating age (days of life is pretty clear).

F Tessa Bartels, CPC, CPC-E/M
Dr. Molteni talked about this at the AMA conference in November. I believe the AMA may have an errata about this. Dr. Moltini defines age as “through age 5” is until the child's 6th birthday (but not on the day of the 6th birthday). Hope that helps.
 

JacquelynA

Contributor
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Location
Houston, Texas
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overlapping ICD-9 age edit

We have an age edit conflict that I need help with, please.
For sexual assault there are two codes;
995.53- sexual assault of a child, (P-indicates that this is a pediatric code; age 0-17)
995.83- sexual assault of an adult, (A-indicates that this is an adult code; age 15-124)

We need clarification so that we can have correct claims edits. Thank you in advance for your help.

Sincerely,
Jackie A., CPC, SCCS
 
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