ISBN-10:
1610020391
ISBN-13:
9781610020398
Pub. Date:
10/01/2016
Publisher:
American Academy of Pediatrics
Coding for Pediatrics 2017: A Manual for Pediatric Documentation and Payment / Edition 22

Coding for Pediatrics 2017: A Manual for Pediatric Documentation and Payment / Edition 22

by American Academy of Pediatrics

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ISBN-13: 9781610020398
Publisher: American Academy of Pediatrics
Publication date: 10/01/2016
Pages: 478
Product dimensions: 9.30(w) x 10.90(h) x 1.00(d)

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Coding for Pediatrics 2017

A Manual for Pediatric Documentation and Payment


By Edward A. Liechty

American Academy of Pediatrics

Copyright © 2017 American Academy of Pediatrics
All rights reserved.
ISBN: 978-1-61002-039-8



CHAPTER 1

New and Revised CPT® Codes for 2017


Current Procedural Terminology (CPT®) is published annually by the American Medical Association. It is used by national carriers and is designated as the official procedure code set under the Health Insurance Portability and Accountability Act of 1996. Current Procedural Terminology codes are known as Level I codes of the broader-based Healthcare Common Procedure Coding System, termed HCPCS. The HCPCS coding system includes Level I codes (CPT-4), Level II codes (Centers for Medicare & Medicaid Services national codes), and Level III codes (local codes assigned and used by Medicare carriers).

Current Procedural Terminology Category I codes are updated annually New or revised codes are effective on January 1 of each year. The symbols on page 4 are used to assist physicians in recognizing the annual revisions made in CPT Exceptions are the vaccine product and Category III (emerging technology) codes, which are updated twice annually (January and July) and, in the case of vaccine products, may be released earlier when specific criteria for rapid release are met.

Current Procedural Terminology includes specific guidelines that are located at the beginning of each section and throughout the CPT manual. Always read the applicable instructions and guidelines before selecting a code.


New, Revised, and Deleted CPT Codes for 2017

The following new codes, revisions, and code deletions are effective with services provided on or after January 1, 2017 We have made every effort to include those procedures and services that are applicable to pediatric practices. However, revisions and/or additional codes may have been published subsequent to the date of this printing. This list does not include all changes made to CPT 2017. Please note that in the interest of efficiency, we will follow the established format of the CPT Editorial Panel meeting minutes; therefore, sections without any revisions will include only the first few italicized words of the section followed by an ellipsis (eg, In the instance where a physician is on call ...). This represents the sections that were unchanged in the CPT 2017 manual to more easily direct you toward the revised text within the guidelines. Always refer to CPT 2017 for a complete listing of new codes, complete descriptions, and revisions.

New text is underlined, deleted text is indicated with a [begin strikethrough]strikethrough[end strikethrough], new codes are identified with the bullet (•) symbol, and revised codes are identified with the triangle (^) symbol.

A few of the changes presented in this chapter include

* New CPT codes 96160–96161 are added for reporting administration of patient-focused (previously 99420) and caregiver-focused health risk assessment (eg, maternal depression inventory) for the benefit of the patient. In conjunction, code 99420 is deleted. Each code represents the administration of a standardized instrument with scoring and documentation.

* Codes 21495 (open treatment of hyoid fracture) and 31582 (laryngoplasty for laryngeal stenosis, with graft or core mold, including tracheotomy) have been deleted. Six new codes describe procedures as currently performed and differentiate treatment of laryngeal stenosis according to age, medialization laryngoplasty, and cricotracheal resection. Codes 31580, 31584, and 31587 are also revised.

* New CPT code 36456 is added for reporting partial exchange transfusion in a newborn.

* The CPT code descriptors for influenza virus vaccine products, 90655–90658 and 90685–90688, were revised to reference dosage rather than age indications.

* Codes for moderate sedation (99143–99145, 99148–99150) have been deleted. New codes 99151–99157 have been added with substantially revised reporting instructions. In conjunction with changes to the codes for moderate sedation, Appendix G and the target symbol (**) previously used to identify procedures that include moderate sedation have been deleted.

* A new modifier (95) and Appendix P are added to identify services that may be reported with modifier 95 to indicate a service was provided via real-time interactive telecommunications system. A new symbol (*) is added before the listing of codes that are included in Appendix P.


Symbols Description

?
A bullet at the beginning of a code means the code is a new code for the current year.

For example,

? 96160 Administration of patient-focused health risk assessment instrument (eg,
health hazard appraisal) with scoring and documentation, per standardized
instrument

^
A triangle means the code descriptor has been revised. For example,

^31580 Laryngoplasty; for laryngeal web, [begin strikethrough]2-stage[end strikethrough], with
indwelling keel or stent insertion [begin strikethrough]and removal[end strikethrough]


Within revised codes, the deleted language appears with a [begin strikethrough]strikethrough[end
strikethrough], while new text appears underlined.

+
A plus sign means the code is an add-on code. For example,

+ 90461 each additional vaccine or toxoid component administered

Ø
A null sign means the code is a "modifier 51 exempt" code and, therefore, does not require
modifier 51 (multiple procedures) even when reported with other procedures. For example,

Ø31500 Intubation, endotracheal, emergency procedure

><
Arrows enclose new or revised text in the current edition of CPT. For example,

> (To report bilateral procedure, report 69210 with modifier 50)>

[??]
The lightning bolt identifies codes for vaccines that are pending US Food and Drug

Administration approval. For example,

[??] 90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for
intradermal use

#
The pound symbol is used to identify re-sequenced codes that are out of numerical sequence.

This allows related codes to be placed in an appropriate location, making it easier to locate a
procedure or service. For example,

# 90621 Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB), 3 dose
schedule, for intramuscular use

O
The O symbol precedes codes that are recycled or reinstated.

*
A star means the service represented by the code is included in Appendix P as a code to which
modifier 95 may be appended to indicate the service was rendered via real-time telemedicine


Category I

Evaluation and Management


Inpatient Neonatal and Pediatric Critical Care

* The same definitions for critical care services apply for the adult, child, and neonate.

Codes 99468 and 99469 are used to report the services of directing the inpatient care of a critically ill neonate or infant 28 days of age or younger. They represent care starting with the day of admission (99468) to a critical care [begin strikethrough]unit[end strikethrough] service and all subsequent day(s) (99469) that the neonate remains in critical care condition. These codes may be reported only by a single individual and only once per calendar day, per patient [begin strikethrough]hospital stay in a given facility[end strikethrough]. Initial inpatient neonatal critical care (99468) may only be reported once per hospital admission. If readmitted to the neonatal critical care [begin strikethrough]unit[end strikethrough] services during the same hospital [begin strikethrough]day-or[end strikethrough] stay,, then report the subsequent [begin strikethrough]day(s)[end strikethrough] inpatient neonatal critical care code (99469) for the first day of readmission to critical care, and 99469 for each day of critical care level of care following readmission.

The initial inpatient [begin strikethrough]day[end strikethrough] neonatal critical care code (99468) can be used in addition to 99464 or 99465 as appropriate, when the physician or other qualified health care professional is present for the delivery (99464) or resuscitation (99465) is required. Other procedures performed as a necessary part of the resuscitation (eg, endotracheal intubation [31500]) [begin strikethrough]are[end strikethrough] may also be reported separately when performed as part of the preadmission delivery room care. In order to report these procedures separately, they must be performed as a necessary component of the resuscitation and not simply as a convenience before admission to the neonatal intensive care unit.

Codes 99471–99476 are used to report the services of directing [begin strikethrough]ion[end strikethrough] of the inpatient care of a critically ill infant or young child from 29 days of postnatal age through 5 years of age [begin strikethrough]less than 6 years of age[end strikethrough]. They represent care starting with the date of admission (99471, 99475) to pediatric critical care services and all subsequent day(s) (99472, 99476) that the infant or child remains incritical condition. These codes may be reported only by a single individual and only once per calendar day, per patient [begin strikethrough]in a given setting[end strikethrough]. Services for the critically ill or critically injured child 6 years of age or older would be reported with the time based critical care codes (99291, 99292). [begin strikethrough]Report[end strikethrough] Initial inpatient critical care (99471, 99475) may only be reported once per hospital admission- stay in a given facility If readmitted to the pediatric critical care unit during the same [begin strikethrough]day-or[end strikethrough]hospital stay, then report the subsequent inpatient pediatric critical care code 99472 or 99476 for the first day of readmission to critical care and 99472 or 99476 for each day of critical care level of care following readmission. <


Preventive Medicine Services

[begin strikethrough]99420 Administration and interpretation of health risk assessment instrument (eg, health hazard appraisal)[end strikethrough]

(For reporting the administration, scoring and documentation of health risk assessment instrument to and about parent/caregiver for benefit of the patient, see 96160-96161.)


Medicine

Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing)

96127Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/ hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument

96160 Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument

96161 Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument


Surgery

Musculoskeletal System

Head

Fracture and/or Dislocation

[begin strikethrough]21495 Open treatment of hyoid fracture[end strikethrough] (21495 has been deleted. To report open treatment of hyoid fracture, use 315841


Respiratory System

Larynx

Repair

^ 31580 Laryngoplasty; for laryngeal web, 2-stage, with indwelling keel or stent insertion and removal

(Do not report 31580 in conjunction with 31551, 31552, 31553, 31554)

(To report tracheostomy, see 31600, 31601, 31603, 31605, 31610)

(To report removal of the keel or stent, use 31599)

[begin strikethrough]31582 for laryngeal stenosis, with graft or core mold, including tracheotomy[end strikethrough]

(31582 has been deleted. To report, see 31551, 31552, 31553, 31554)

31551 for laryngeal stenosis, with graft, without indwelling stent placement, younger than 12 years of age

(Do not report graft separately if harvested through the laryngoplasty incision [eg, thyroid cartilage graft])

(Do not report 31551 in conjunction with 31580, 31552, 31553, 31554)

(To report tracheostomy see 31600, 31601, 31603, 31605, 31610)


31552 for laryngeal stenosis, with graft, without indwelling stent placement, age 12 years or older

(Do not report graft separately if harvested through the laryngoplasty incision [eg, thyroid cartilage graft])

(Do not report 31552 in conjunction with 31580, 31551, 31553, 31554)

(To report tracheostomy see 31600, 31601, 31603, 31605, 31610)


31553 for laryngeal stenosis, with graft, with indwelling stent placement, younger than 12 years of age

(Do not report graft separately if harvested through the laryngoplasty incision [eg, thyroid cartilage graft])

(Do not report 31553in conjunction with 31580, 31551, 31552, 31554)

(To report tracheostomy see 31600, 31601, 31603, 31605, 31610)

(To report removal of the stent, use 31599)


31554 for laryngeal stenosis, with graft, with indwelling stent placement, age 12 years or older

(Do not report graft separately if harvested through the laryngoplasty incision [eg, thyroid cartilage graft])

(Do not report 31554 in conjunction with 31580, 31551, 31552, 31553)

(To report tracheostomy see 31600, 31601, 31603, 31605, 31610)

(To report removal of the stent, use 31599)


^ 31584 with open reduction and fixation (eg, plating) of fracture, includes tracheostomy, if performed

(Do not report graft separately if harvested through the laryngoplasty incision [eg, thyroid cartilage graft])


^ 31587 Laryngoplasty, cricoid split, without graft placement

(To report tracheostomy see 31600, 31601, 31603, 31605, 31610)

[begin strikethrough]31588 Laryngoplasty, not otherwise specified (eg, for burns, reconstruction after partial laryngectomy)[end strikethrough]

(31588 has been deleted. To report laryngoplasty not otherwise specified, use 31599)

31591 Laryngoplasty, medialization, unilateral

31592 Cricotracheal resection

(Do not report graft separately if harvested through cricotracheal resection incision [eg, trachealis muscle])

(Do not report local advancement and rotational flaps separately if performed through the same incision)

(To report tracheostomy see 31600, 31601, 31603, 31605, 31610)

(To report excision of tracheal stenosis and anastomosis, see 31780, 31781)

Please see Chapter 13, Ear, Nose, and Throat Procedures, for more information and examples of coding for laryngoplasty.


Cardiovascular System

Cardiac Valves

Aortic Valve

[begin strikethrough]33400 Valvuloplasty, aortic valve; open, with cardiopulmonary bypass

33401 open, with inflow occlusion

33403 using transventricular dilation, with cardiopulmonary bypass

(Do not report modifier 63 in conjunction with 33401, 33403)[end strikethrough]

(33400, 33401, 33403 have been deleted. To report, see 33390, 33391)

[??] 33405 Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve

[??] 33406 with allograft valve (freehand)

[begin strikethrough](For aortic valve valvotomy [commissurotomy] with inflow occlusion, use 33401)

(For aortic valve valvotomy [commissurotomy] with cardiopulmonary bypass, use 33403)[end strikethrough]

[??] 33401 with stentless tissue valve


33390 Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; simple (ie, valvotomy, debridement, debulking, and/or simple commissural resuspension)

33391 complex (eg, leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty)

(Do not report 33391 in conjunction with 33390)


Heart/Lung Transplantation

33944 Backbench standard preparation of cadaver donor heart allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, pulmonary artery, and left atrium for implantation

(For repair or resection procedures on the donor heart, see 33300, 33310, 33320, 33400, 33390, 33463, 33464, 33510, 33641, 35216, 35276 or 35685)

Please see Chapter 13, Cardiovascular Procedures, for more information on changes to the codes for valvuloplasty.


(Continues...)

Excerpted from Coding for Pediatrics 2017 by Edward A. Liechty. Copyright © 2017 American Academy of Pediatrics. Excerpted by permission of American Academy of Pediatrics.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents

Foreword .....................................................................................................................................  

Acknowledgments.......................................................................................................................

Chapter 1

New and Revised CPT® Codes for 2017......................................................................................

Chapter 2

Diagnosis Coding: ICD-10-CM......................................................................................................

Chapter 3

Modifiers and Coding Edits........................................................................................................

Chapter 4

Evaluation and Management: Documentation and Coding Guidelines, Telehealth, and PATH Guidelines......................................................................................................................................................

Chapter 5

Preventive Services.....................................................................................................................

Chapter 6

Evaluation and Management Services in the Office, Outpatient, Home, or Nursing Facility Setting  

Chapter 7

Managing Chronic and Complex Conditions............................................................................

Chapter 8

Pre-birth Counseling and Care of the Newborn.......................................................................

Chapter 9

Noncritical Hospital Evaluation and Management Services..................................................

Chapter 10

Emergency Department Services..............................................................................................

Chapter 11

Critical and Intensive Care.........................................................................................................

Chapter 12

Allied Health and Clinical Staff Services..................................................................................

Chapter 13

Common Procedures and Non–Evaluation and Management Medical Services..................

Chapter 14

Coding to Demonstrate Quality and Value...............................................................................

Chapter 15

Preventing Fraud and Abuse: Compliance, Audits, and Paybacks.........................................

Chapter 16

The Business of Medicine: Working With Current and Emerging Payment Systems..........

Chapter 17

Continuing Education Units (CEUs) for American Academy of Professional Coders..........

Appendixes

NOTE: Appendixes preceded by  can be located online at www.aap.org/cfp, access code AAPCFP22.

Appendix A

 1995 Documentation Guidelines for Evaluation and Management Services................ 9

 1997 Documentation Guidelines for Evaluation and Management Services ..................  

 Physicians at Teaching Hospitals (PATH) Guidelines (online only)................................

 MLN Matters SE0441—CMS Incident-To Requirements (online only)............................

Appendix B. Your Coding Toolkit

 Figure B-1. CPT® Coding Change Request Form (online only)..........................................

 Figure B-2. FAQ: Immunization Administration (online only)........................................

 Figure B-3. Vaccine Products (online only)........................................................................

 Figure B-4. Sample Assessment/Testing Tools...................................................................

 Figure B-5. Chronic Care Management Worksheet...........................................................

 Figure B-6. Care Plan Oversight Encounter Worksheet....................................................

 Figure B-7. Global Per Diem Critical Care Codes: Direct Supervision and Reporting Guidelines 

 Figure B-8. Sample Denial Tracking Tool...........................................................................

 Figure B-9. FAQ: Alternative Payment Methodologies (online only)...............................

 Figure B-10. Claim Correction Form (online only)............................................................

 Figure B-11. Effective Health Plan Appeals: The Ins and Outs..........................................

 Figure B-12. Sample Appeal Letter (online only)...............................................................

 Figure B-13. Marshfield Audit Tool (online only)..............................................................

 Figure B-14. Coding Fact Sheets (online only)....................................................................

Appendix C

 Asthma Clinical Performance Measures (online only)......................................................

Appendix D

2017 Pediatric Coding Resources Exclusively From the AAP.................................................

Indexes

Subject Index...............................................................................................................................

Code Index...................................................................................................................................

AAP/Bright Futures “Recommendations for Preventive Pediatric Health Care” (Periodicity Schedule)............................................................................................................................................ Insert

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