1. Presented by: Raemarie Jimenez, CPC, CPC-I, CANPC, CRHC
PEDIATRIC CPT® CODING
Materials by: Jacqueline J. Stack, CPC, CPC-I, CEDC
Presented by: Raemarie Jimenez, CPC, CPC-I, CANPC, CRHC

2. CPT® Disclaimer
CPT® copyright 2009 American Medical Association. All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT® is a registered trademark of the American Medical Association.

3. Agenda Newborn Critical Care Inpatient Consultation E/M
Preventive Care
Modifiers
Non Face-to-face
Common Procedures

4. Newborn
Initial hospital or birthing center care, per day, for E/M of normal newborn infant
99460
Subsequent hospital care, per day, for E/M of normal newborn
99462
Normal Newborn Discharge
Initial hospital or birthing center care, per day, for E/M of normal newborn infant admitted and discharged on the same date
99463

5. Attendance at Delivery
Attendance at delivery (when requested by the delivering physician) and initial stabilization of newborn 99464

6. Standby Services/Resuscitation
Delivery/birthing room resuscitation , provision of positive pressure violation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output
99465

7. Inpatient Neonatal and Pediatric Critical Care
Initial inpatient neonatal critical care, per day, for the E/M of a critically ill neonate, 28 days of age or less
99468
Subsequent inpatient neonatal critical care, per day, for the E/M of a critically ill neonate, 28 days of age or less
99469

8. Inpatient Neonatal and Pediatric Critical Care
Initial inpatient pediatric critical care, per day, for the E/M of a critically ill infant or young child, 29 days through 24 months of age
99471
Subsequent inpatient pediatric critical care, per day, for the E/M of a critically ill infant or young child, 29 days through 24 months of age
99472

9. Inpatient Neonatal and Pediatric Critical Care
Initial inpatient pediatric critical care, per day, for the E/M of a critically ill infant or young child, 2 through 5 years of age
99475
Subsequent inpatient pediatric critical care, per day, for the E/M of a critically ill infant or young child, 2 through 5 years of age
99476

10. Intensive Care Services
Initial hospital care, per day, for the E/M of the neonate, 28 days of age or less, who requires intensive observation, frequent interventions, and other intensive care services
99477
Subsequent intensive care, per day, for the E/M of the recovering very low birth weight infant (present body weight less than 1500 grams)
99478
(present body weight of grams)
99479
(present body weight of grams)
99480

11. Pediatric Critical Care Patient Transport
Critical care services delivered by a physician, face-to-face, during an inter facility transport of critically ill or critically injured pediatric patient, 24 months of age or less; first minutes of hands-on care during transport
99466
Each addition 30 minutes
99467

12. Inpatient Initial hospital care, per day, for the E/M of a patient
Subsequent hospital care, per day, for the E/M of a patient
Hospital discharge day management; 30 minutes or less
99238
More than 30 minutes
99239

13. Observation
Initial observation care, per day, for the E/M of a patient
Observation care discharge day management
99217
Observation or inpatient hospital care, for the E/M of a patient including admission and discharge on the same date
99234 – 99236

14. Consultations Inpatient consultation for a new or established patient
Office consultation for a new or established patient

15. 3 Rs of a Consult
Request
Rendered opinion
Written Report

16. Evaluation and Management
New vs. established patients
Office or other outpatient visit for the E/M of a new patient
Office or other outpatient visit for the E/M of an established patient

17. New vs. Established Example:
A new provider joins your practice. He has been practicing in your area for some time. Some of his patients from the previous office that he worked at is now coming to your office. Are they considered new or established?
You providers are covering for another provider in the hospital. The patient has since decided to switch to your practice. When they come in to our office for an appointment - lets say 4 months later - are they new or established?
A newborn comes into the office. It is the first time the baby has been in your office. Is the baby new or established?

18. E/M Chief Complaint History History of Present Illness
Review of Systems
Past Medical, Social or Family History
Exam
95 vs. 97 guidelines
Medical Decision Making
Number of diagnoses or management
Amount and/or complexity of data
Risk of complications

19. Time Counseling and/or coordination of care Face to face time
Floor/unit time
Documentation

20. Prolonged Services
Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; first hour
99354
Each additional 30 minutes
99355
Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour
99356
99357

21. Preventive Care
Initial comprehensive preventive medicine E/M of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient
Periodic comprehensive preventive medicine, established patient

22. Modifier 25
Per CPT® Modifier 25 is Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.

23. Preventive Medicine Visit
What does CPT® mean by: “If an abnormality/ies is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem/abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate Office/Outpatient code should also be reported.

24. Five Questions Intent? Is it Minor? Will the Patient Return?
Is the additional problem significant?
Documentation?

25. Preventive with E/M
Example: A six-year-old is seen for an age-appropriate established preventive medicine visit. Earlier in the day the child fell and injured his arm. The provider performs an X-ray and refers the patient to orthopedics. Can this provider charge the preventive and an E/M on this same day?

26. Preventive with E/M
Example:
A 3-year-old is seen for an age-appropriate established preventive medicine visit. Seven days ago the patient was seen for an otitis media. The patient’s otitis media is resolved.
Can this provider charge the preventive and an E/M on this same day?

27. Problems/Issues School Physicals Sport Physicals
Driver License Physicals
Work Physicals
Frequency Limits
No Coverage

28. Vaccine Counseling
Immunization administration younger than 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; first injection (single or combination vaccine/toxoid), per day
90465
Each additional injection
90466

29. Vaccine Counseling
Immunization administration younger than 8 years (includes intranasal or oral route of administration) when the physician counsels the patient/family; first administration (single or combination vaccine/toxoid), per day
90467
Each additional administration
90468

30. Vaccine Counseling
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid)
90471
Each additional vaccine
90472

31. Vaccine Counseling
Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)
90473
Each additional vaccine
90474

32. Common Immunizations Hepatitis A & B Influenza
Human papilloma virus (HPV)
Pneumococcal
Rotavirus
Measles, mumps, and rubella
Diphtheria, tetanus and pertussis
Poliovirus
Varicella
Meningococcal

33. Immunization Proper Route/Oral vs. Injected Proper Documentation
Route (site)
Amount
Lot Number
VIS – vaccine information sheet
Age of Patient
Did Doctor do the counseling?
Individual or combination vaccine
Number of Injections
90472 Each Additional Vaccination

34. Immunizations and Administration
Example: A 16-year-old female is seen for her preventive visit and received HPV, meningococcal and tetanus, diphtheria and pertussis vaccines. What administration codes are used with the vaccine codes?

35. Immunizations and Administration
Example:
A 2-month-old baby is seen for a well child check. The baby also receives the 2 month immunizations. The baby receives a DtaP, HIB, IPV, Prevnar and Rotavirus.
How would you code these immunizations and administration?
With counseling, the vaccine administrations are coded with 90465, x 3,
Without counseling, the vaccine administrations are coded with 90471, x 3,
Please note the code referenced in the audio is incorrect. The correct codes are provided on this slide.

36. Screening Services Hearing screening, pure tone, air only test 92551
Vision screening, test of visual acuity, quantitative, bilateral
99173
Urinalysis

37. Development Tests
Developmental testing; limited (eg. Developmental Screening Test II, Early Language Milestone Screen), with interpretation and report
96110
Extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report
96111

38. Modifiers
24 - Unrelated E/M service by the same physician during a postoperative period Example: Patient was seen three days ago for wound repair in office. Today the patient is being seen for an upper respiratory infection.

39. Modifiers 52 Reduced Services Example:
The provider is unable to complete a visit as planned due to the child’s disruptive behavior.

40. Non Face-To-Face Physician Services
Telephone E/M service provided by a physician to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
99441
11-20 minutes
99442
21-30 minutes
99443

41. On-Line Medical Evaluation
Online E/M service provided by a physician to an established patient, guardian, or health care provider not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network
99444

42. Non-Face-To-Face Nonphysician Services
Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
98966
11-20 minutes of medical discussion
98967
21-30 minutes of medical discussion
98968

43. On-Line Medical Evaluation
Online assessment and management service provided by a qualified nonphysician health care professional to an established patient, guardian, or health care provider not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network 98969

44. Common Procedures Venipuncture (36400-36425) Strep Tests (87880)
Cerumen Removal (69210)
Foreign Body Removal (69200, 30300)
Wart Removal/Lesions( , , )

45. Common Procedures Simple Repair (12001-12021)
Intermediate Repair ( )
Complex Repair ( )
Circumcision/Penile Adhesions ( )
Aerosol Treatment ( )
Post Op 99024
Suture Removal

46. References
American Academy Of Pediatrics (2008). Coding for Pediatrics (13th ed.).
American Medical Association (2009). CPT® Current Procedural Terminology (Professional Edition ed.).