aap pediatric coding newsletter for specific coding questions, contact the aap coding hotline at...

Getting Paid in 2019: Relative Value Units and Conversion Factors

Subspecialty Coding News: 2019 Neurobehavioral Status Examination Codes

CPT® 2019: Psychological and Neuropsychological Testing

Interprofessional Assessment and Management 2019: Reporting Referring and Consulting Services

Peripherally Inserted Central Venous Catheters and Midline Catheter Placement Coding in 2019

Q&A

November 2018 | Volume 14 | Number 2coding.aap.org

AAP Pediatric Coding Newsletter™

Proven coding guidance from the American Academy of Pediatrics

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2 | AAP Pediatric Coding Newsletter™ | http://coding.aap.org | November 2018

AAP Pediatric Coding Newsletter™ Volume 14, Number 2, ISSN 1934-5135 (Print), ISSN 1934-5143 (Online) is published monthly by the American Academy of Pediatrics, 345 Park Blvd, Itasca, IL 60143. © 2018 American Academy of Pediatrics. All rights reserved. Periodicals postage paid at Arlington Heights, IL, and additional entries.

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© 2018 American Academy of Pediatrics. CPT is © 2017 American Medical Association. All Rights Reserved.

For specific coding questions, contact the AAP Coding Hotline at [email protected].

This newsletter has prior approval of the American Academy of Professional Coders (AAPC) for 0.5 continuing education units. Granting of this approval in no way constitutes endorsement by AAPC of the publication, content, or publication sponsor. Log on to http://coding.aap.org to access the quiz for this and past issues.

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

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Vignettes are provided to illustrate correct coding applications and are not intended to offer advice on the practice of medicine.

CONSULTING EDITORSCindy Hughes, CPC, CFPCZachary Hochstetler American Medical Association Director, CPT® Coding, Editorial and Regulatory Services

STAFF EDITORSBecky Dolan, MPH, CPC, CPEDCTeri Salus, MPA, CPC, CPEDCLinda Walsh, MAB

EDITORIAL BOARDLinda D. Parsi, MD, MBA, CPEDC, EditorDavid M. Kanter, MD, MBA, CPC Chairperson, Committee on Coding and NomenclatureVita Boyar, MDJoel F. Bradley, MDSteven E. Krug, MDEdward A. Liechty, MDJeffrey F. Linzer Sr, MDJeanne Marconi, MDRichard A. Molteni, MDJulia M. Pillsbury, DORenee F. Slade, MDSanjeev Y. Tuli, MD

AMERICAN ACADEMY OF PEDIATRICS PUBLISHING STAFFMary Lou White Chief Product and Services Officer/SVP, Membership, Marketing, and PublishingMark Grimes Vice President, Publishing Heather Babiar, MS Senior Editor, Professional/Clinical PublishingJason Crase Manager, Editorial ServicesLeesa Levin-Doroba Production Manager, Practice ManagementLinda Diamond Manager, Art Direction and ProductionMaryjo Reynolds Marketing Manager, Practice Publications

Proven coding guidance from the American Academy of Pediatrics

CONTENTS

3 Getting Paid in 2019: Relative Value Units and Conversion Factors

4 Subspecialty Coding News: 2019 Neurobehavioral Status Examination Codes

5 CPT® 2019: Psychological and Neuropsychological Testing

7 Interprofessional Assessment and Management 2019: Reporting Referring and Consulting Services

10 Peripherally Inserted Central Venous Catheters and Midline Catheter Placement Coding in 2019

11 Q&A

12 AAP Pediatric Coding Newsletter™ Quiz

AAP PediatricCoding Newsletter™


AAP Pediatric Coding Newsletter™ | http://coding.aap.org | November 2018 | 3

More About Relative Value Units

The AAP provides further explanation of how relative value units are used to determine payment for physician services at https://www.aap.org/en-us/Documents/2018%20RBRVS.pdf.

Comparison of 2018 to Proposed 2019 Medicare Physician Fee Schedule National Average Payments for Select Pediatric Servicesa

Serviceb 2018 MPFS RVUs and Allowed Amount 2019 MPFS RVUs and Allowed Amount

17250 Chemical cauterization of granulation tissue (i.e., proud flesh)

2.29c $82.441.07d $38.52

2.33c $83.991.05d $37.85

30300 Remove nasal foreign body5.02c $180.723.00d $108.00

5.06c $182.393.04d $109.58

69200 Clear outer ear canal2.33c $83.881.35d $48.60

2.26c $81.461.32d $47.58

69210 Remove impacted ear wax, unilateral1.38c $49.680.94d $33.84

1.32c $47.580.92d $33.16

96110 Developmental screen w/ score 0.29c $10.44 0.30c $10.81

96372 Therapeutic, prophylactic, or diagnostic injection, SC/IM 0.58c $20.88 0.47c $16.94

99188 Application of topical fluoride varnish0.35c $12.600.29d $10.44

0.35c $12.620.29d $10.45

99221 Initial hospital care 2.87d $103.32 2.88d $103.81

99391 Preventive visit, established patient, infant 2.81c $101.16 2.83c $102.01

99460 Initial newborn E/M per day, hospital 2.71d $97.56 2.77d $99.85

99468 Neonate, critical care, initial 26.04d $937.43 26.48d $954.51

99495 Transitional care management, 14 day, discharge4.64c $167.043.12d $112.32

4.87c $175.553.23d $116.43

Abbreviations: E/M, evaluation and management; IM, intramuscular; MPFS, Medicare Physician Fee Schedule; RVU, relative value unit; SC, subcutaneous; w/, with.a Not geographically adjusted; proposed 2019 RVUs are subject to change prior to implementation. Conversion factors: 2018, $35.99; 2019, $36.05.b See Current Procedural Terminology® for full code descriptors.c Non-facility total RVUs.d Facility total RVUs.

Getting Paid in 2019: Relative Value Units and Conversion FactorsMost services provided by pediatricians are paid for on a fee-for- service basis. Fee-for-service payment is typically based on the Medicare Physician Fee Schedule (MPFS), including relative value units (RVUs) assigned to procedure codes and a conversion factor or dollar amount paid per RVU. (Medicare payment is

also affected by geographic prac-tice cost indexes that may increase or decrease the RVUs assigned to codes.) Both RVUs and conversion factors are subject to

change annually in the updates to the MPFS. In 2018, the conversion factor for the MPFS is $35.99 (35.9996). The conversion factor for 2019 is proposed to be $36.05 (36.0463). Anesthesia services (general and monitored anesthesia, deep sedation) are paid with a separate conversion factor proposed at $22.30 (22.2986) per anesthesia unit for 2019.

Note that not only the conversion factor changed; the RVUs for many services are also slightly increased or decreased. Keep watch on your payer contracts and know the basis for private payer fee schedules. Depending on the services you provide, it may be beneficial to negotiate use of the RVUs published in the 2019 MPFS.

If you contract with a payer that uses the current MPFS RVUs and conversion factor, you might see changes in payment such as those shown in the Table. (Not all payers who use the MPFS use the current year’s RVUs and/or the MPFS conversion factor. Check your payer contracts for actual fee schedule calculations.)

It’s useful to know the RVU assignments for codes that are new or revised in 2019. Knowing the RVUs assigned to a service can provide a source for estimating payments for services you may add and the effects of changes to codes for services you already provide. RVUs for new and revised codes are included in the articles in this issue of AAP Pediatric Coding Newsletter™. Estimate payment under private payer and Medicaid contracts that use RVUs by multiplying the RVUs by each plan’s conversion factor (eg, $36.05 per RVU). Actual payment may vary based on individual plan fee schedule calculations.



Code 96116 now includes a period of 1 hour (first hour of testing). New code 96121 is reported for each additional hour. As specifically noted in the code descriptor for neurobehavioral status examination, the physician or qualified health care professional’s time of face-to-face testing and time interpreting test results and preparing a report are included in the time reported for these services.

More From the AAP: Developmental Testing

See also discussion of new codes for developmental testing in the October 2018 AAP Pediatric Coding Newsletter™ at https://coding.aap.org.

▲96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), by physician or other qualified health care professional, both face-to-face time with the patient and time inter-preting test results and preparing the report; first hour

✚96121 each additional hour

Neurobehavioral status examination involves clinical assessment for impairments in acquired knowledge, attention, language, learning, memory, problem-solving, and visual-spatial abilities and includes development of a clinical impression and production of a written summary of findings that may include recommendations for further assessment, treatment, and/or follow-up.

Documentation of these services includes scoring, informal observation of behavior during the testing, and interpretation and report. It should include the date and time spent in testing and time of interpretation and report.

EXAMPLE

An 8-year-old boy, previously diagnosed with attention-deficit/hyperactivity disorder, is being evaluated for gradual problems with remembering directions, organizing his school materials and his room at home, and other behavior concerns. The Woodcock-Johnson Tests of Cognitive Abilities, 4th Edition, is administered, scored, and interpreted in a written report. The results indicate the need for further language, memory, and intelligence testing. The total time for testing, scoring, and report writing is 3½ hours.

This service is reported with code 96116 (neurobehavioral status examination) and 96121 with 2 units for the additional 2 hours of testing, scoring, and report writing. The diagnosis code is International Classification of Diseases, 10th Revision,

Clinical Modification (ICD-10-CM) code F90.9 (attention deficit- hyperactivity disorder, unspecified type). Additional ICD-10-CM codes may be assigned for specific developmental disorders diagnosed following testing (eg, F81.2, mathematics disorder).

Relative Value Unitsa of Neurobehavioral Status Examination in 2019

Code Total Non-facility RVUs Change in RVUs From 2018 Total Facility RVUs Change in RVUs From 2018

96116 2.70 +0.05 (2.65) 2.42 Unchanged

96121 2.32 +2.32 (new code) 2.22 +2.22 (new code)

Abbreviation: RVU, relative value unit.aNot geographically adjusted; proposed RVUs are subject to change prior to implementation.

Subspecialty Coding News: 2019 Neurobehavioral Status Examination Codes

Symbols: ▲, revised code descriptor; ✚, add-on code (used only secondary to a code for the primary service); ●, new code in 2019.

October 2018 Edition Errata

The new codes of Changing of Gastrostomy Tube were incorrect and are correct as follows:

●43762 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract●43763 requiring revision of gastrostomy tract



...continued on page 6

CPT® 2019: Psychological and Neuropsychological Testing

Current Procedural Terminology (CPT) 2019 introduces multiple changes to codes for psychological and neuropsychological testing services.

• Codes 96101–96103 (psychological testing) have been deleted. To report psychological testing evaluation services and test administration and scoring services, see codes 96130, 96131, and 96136–96146.

• Codes 96118–96120 (neuropsychological testing) have been deleted. To report neuropsychological testing evaluation and administration and scoring services, see 96132–96146.

The new codes for psychological and neuropsychological testing are not direct crossovers from the current codes. Instructions for reporting are also revised and added. Tables 1 and 2 contrast the different services described by these codes. Examples of psychological tests include Screen for Child Anxiety Related Disorders (SCARED) and Children’s PTSD [posttraumatic stress disorder] Inventory (CPTSDI). Examples of neuropsychological tests are the Wechsler Intelligence Scale for Children, 4th Edition (WISC-IV), and Differential Abilities Scale-II (DAS-II).

Relative Value Unitsa of Physician/Other Qualified Health Care Profes-sional Psychological/Neuropsychological Testing Evaluation Services

Code Total Non-facility RVUs Total Facility RVUs

96130 3.30 3.12

96131 2.49 2.34

96132 3.70 3.03

96133 2.82 2.31

Abbreviation: RVU, relative value unit.aNot geographically adjusted; proposed 2019 RVUs are subject to change prior to implementation.

Table 1. Physician or Other Qualified Health Care Professional Administered Psychiatric/Neuropsychiatric Testing

Single test administered96127 Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument

≥2 Tests Administered

●96130

Psychological testing evaluation services by physician or other QHP, including

• integration of patient data, • interpretation of standardized test results and clinical data, • clinical decision making, treatment planning and report, and • interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour

●96132

Neuropsychological testing evaluation services by physician or other QHP, including

• integration of patient data, • interpretation of standardized test results and clinical data, • clinical decision making, treatment planning and report, and • interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour

●96136

Psychological or neuropsychological test administration and scoring by physician or other QHP, two or more tests, any method, first 30 minutes

Do not include time for evaluation services (e.g., integration of patient data or interpretation of test results). Report 96130–96133 for time spent in testing evaluation services.

✚●96131 each additional hour (Report in addition to 96130)

✚●96133 each additional hour (Report in addition to 96132)

✚●96137 each additional 30 minutes after first 30 minutes (Report in addition to 96136)

Abbreviation: QHP, qualified health care professional.

Table 2. Technician-Administered Psychiatric/Neuropsychiatric Testing

●96138 Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method;

first 30 minutesDo not report services of less than 16 minutes

✚●96139 each additional 30 minutes(Report in addition to code 96138 with one unit for each additional 30 minutes or the final 16-30 minutes.)

TIPMini–mental status examination performed by a physician or other qualified health care professional is included as part of the nervous system physical examination of an evaluation and management service and not separately reportable.



Coding Tips and Examples• Psychological/neuropsychological testing services follow

standard CPT time definitions where time is met when the midpoint is passed (eg, a minimum of 31 minutes must be provided to report any per-hour code). Report the total time at the completion of the entire episode of evaluation.

• Do not report administration of a single test by a physician, other qualified health care professional (QHP), or technician using codes 96130–96139. See code 96127, brief emotional/behavioral assessment (eg, depression inventory, attention- deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument for administra-tion of a single test unless administered via an electronic platform. Administration of a single test via electronic platform is reported with code 96146.

• Psychological/neuropsychological testing evaluation services (96130–96133) do not include the time spent by a physician or QHP administering tests. Time includes interpretation of tests, integration of patient data, clinical decision-making, diagnosis and/or treatment planning, and, when performed, interactive feedback.

• Testing evaluation services (96130–96133) require an interpretation and a report.

• Report codes 96136 and 96137 for test administration by a physician or QHP whether on the same or a different date from the testing evaluation services.

− Codes are selected based on the time of test administration only. Do not include time of testing evaluation services.

• Test administration and scoring by a technician (96138 and 96139) do not include the work of a physician or QHP. These codes are valued for practice expense and medical liability only.

− These services may be provided on the same date as physician or QHP test administration or testing evaluation service.

− Do not include time for evaluation services (eg, integration of patient data or interpretation of test results) in the time of technician-administered testing.

• Documentation of testing administration services (96136–96139) includes administration of a series of tests, observa-tion of behavior, scoring, and transcription of scores onto a data summary sheet. It should include the date and time spent in testing, reason for the testing, and titles of all instruments used.

CPT® 2019: Psychological and Neuropsychological Testing ...continued from page 5

Tables 3 and 4 provide references to the required times for reporting codes 96130–96133 and 96136–96139, as demonstrated in the following examples:

EXAMPLE

An adolescent whose family reports psychotic behavior is referred for psychological testing evaluation. The patient under-goes physician-administered psychological testing to evaluate emotionality, intellectual abilities, personality, and psychopathol-ogy and to make a mental health diagnosis and treatment recom-mendations, as applicable. The total time of face-to-face testing of 50 minutes is reported with codes 96136 and 96137. The physician’s total time of data integration, interpretation, and report preparation is 75 minutes. Code 96130 is reported for the testing evaluation service.

Table 3. Reporting Time: Codes 96130–96133

Minutes Code(s) Reported

<30 Not reported

31–90 96130

≥91–150 96130, 96131 x 1 unit for each 31 minutes beyond the last full hour

EXAMPLE

An adolescent patient is referred for neuropsychological testing due to chronic physical symptoms without clinical findings and declining academic achievement. A physician spends 50 minutes administering tests, recording observations, scoring, and tran-scribing results to a data summary sheet. Codes 96136 and 96137 are reported with 1 unit of service each. Because the time of service exceeded 16 minutes beyond the first 30 minutes, code 96137 is reported in addition to 96136. Neuropsychological testing evaluation services (96132 and 96133) will be provided and reported on a separate date.

Table 4. Reporting Time: Codes 96136–96139

Minutes Code(s) Reported

<16 Not reported

16–30 96136 or 96138

≥31–45 96136, 96137 x 1 unit or 96138, 96139 x 1 unit for each 16 minutes beyond the last full hour

EXAMPLE

An adolescent patient is referred for neuropsychological testing due to chronic physical symptoms without clinical findings and declining academic achievement. A technician spends 40 minutes administering and scoring tests. The technician also notes any behavioral observations. Code 96138 is reported with 1 unit of service. Code 96139 is not reported because the time of service did not exceed 16 minutes beyond the first 30 minutes.




Interprofessional Assessment and Management 2019: Reporting Referring and Consulting ServicesAn interprofessional telephone/Internet/electronic health record (EHR) assessment and management service occurs when a patient’s treating (eg, attending, primary) physician or other quali-fied health care professional (QHP) requests the opinion and/or treatment advice of a physician with specific specialty expertise (the consultant) to assist the treating physician or QHP in the diagnosis and/or management of the patient’s problem without patient face-to-face contact with the consultant. When the sole purpose of the telephone/Internet/EHR communication is to arrange a transfer of care or face-to-face service, these codes are not reported.

Codes for interprofessional telephone and Internet consultation (99446–99449) are changed in Current Procedural Terminology (CPT®) 2019 to include communication via EHR but still include verbal and written reports from the consultant to the referring provider. However, new code 99451 allows a consultant to report consultative time of 5 minutes or more spent in medical consulta-

tion with a written report to the referring provider (no verbal report required). Code 99452 is added allowing a refer-ring physician or QHP to report 16 to 30 minutes or more of referral services.

The Table includes the codes and descriptors, relative value units (RVUs), and allowed amounts proposed for the interprofessional assessment and management services in the Medicare Physician Fee Schedule (MPFS) for 2019. Payers other than Medicare may assign other values to these codes. Check individual payer contracts and fee schedules for specific information. (NOTE: Codes 99446–99449, 99451, and 99452 are assigned NA [not applicable] in the non-facility RVUs column of the proposed MPFS. However, NA in this column indicates that the facility RVUs will be paid when payment is made for the service provided in a non-facility setting.)

Rules for ReportingInterprofessional assessment and management codes are reported for consultation with a physician or QHP and not with a patient and/or caregiver. Time spent in telephone or online consultation with the patient and/or caregiver may be reported using codes 99441–99444 (telephone or online evaluation and

management [E/M] service by a physician or QHP), and the time related to these services is not included in the time attributed to interprofessional consultation services.

Interprofessional assessment and management services are not reported if the consultant has provided a face-to-face service to the patient within the past 14 days or when the consultation results in scheduling of a face-to-face service within the next 14 days or at the consultant’s next available appointment date.

2019 Codes and Relative Value Units for Interprofessional Assessment and Management Services

Facility RVUsa

Allowed Amounta

▲99446 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review

0.51 $18.38

▲99447 11-20 minutes of medical consultative discussion and review

1.00 $36.05

▲99448 21-30 minutes of medical consultative discussion and review

1.51 $54.43

▲99449 31 minutes or more of medical consultative discussion and review

2.02 $72.81

●99451 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician including a written report to the patient’s treating/requesting physician or qualified health care professional, 5 or more minutes of medical consultative time

0.74 $26.67

●99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified health care professional, 30 minutes

0.74 $26.67

Abbreviation: RVU, relative value unit.

Symbols: ▲, revised code descriptor; ●, new code in 2019.a Values are based on the proposed rule for the Medicare Physician Fee Schedule for 2019 and are subject to change. The proposed conversion factor of $36.0463 was used in calculating allowed amounts.

Requesting Physician Interprofessional Consultation Time

A physician may report 16 to 30 minutes of time spent in telephone/Internet/ electronic health record referral services with code 99452 or report prolonged service codes for more than 30 minutes spent in referral services.




The Consultant’s TimeIf more than 50% of the time for the service is devoted to data review and/or analysis, codes 99446–99449 should not be reported. However, the service time for code 99451 is based on total time of data review and interprofessional communication regardless of the percentage of time spent in data review and/or analysis.

Codes 99446–99451 should not be reported more than once within a 7-day interval. Report a single code for the total cumula-tive time of service when more than 1 telephone/Internet/EHR contact is necessary to complete a consultation service. Services of fewer than 5 minutes are not reported.

Time spent by the consultant reviewing pertinent medical records, studies, or other data is included in the interprofessional consulta-tion and not separately reported. Do not report prolonged service codes 99358 and 99359 for any time within the service period of codes 99446–99451.

Reporting Referral ServicesA treating/requesting physician or QHP may report an interprofessional referral service or prolonged service for time spent preparing for referral and/or communicating with a consultant. Code 99452 may be reported when 16 to 30 minutes is spent on a service day preparing for the referral and/or communicating with the consultant (eg, discussing patient history, receiving verbal report from a consultant). Code 99452 is not reported more than once in a 14-day period.

Prolonged face-to-face service (99354–99357) during the interprofessional telephone/Internet/EHR discussion with the consultant (eg, specialist) may be reported by the treating physi-cian or QHP for the time spent if the time exceeds 30 minutes beyond the typical time of the E/M service performed and the patient is on-site and available during the service. Codes 99354–99357 are add-on codes reported only in addition to an E/M or psychotherapy service provided on the same date. Non–face-to-face prolonged service (99358, 99359) may be reported by the treating physician or QHP when the time of the interprofessional

telephone/Internet/EHR referral service exceeds 30 minutes in a day when the patient is not on-site.

EXAMPLE

A pediatrician caring for a child with predominantly hyperactive attention-deficit/hyperactivity disorder (ADHD) evaluates the child, who is experiencing increased behavior issues at home and school. The pediatrician determines that consultation with a child and adolescent psychiatrist is necessary to aid in development of a new care plan. The pediatrician reports the appropriate office or other outpatient E/M service code (eg, 99214). Diagnosis code F90.1 (ADHD, predominantly hyperactive type) is reported.

The pediatrician arranges a telephone consultation with the psychiatrist to take place on another date and forwards pertinent medical records for review. The telephone consultation is con- ducted with the child and parents present in the pediatrician’s office and lasts 20 minutes. The pediatrician reports code 99452 because the time of service exceeds 16 minutes. The psychiatrist reports 99447 (interprofessional assessment and management, 11–20 minutes of medical discussion and review).

EXAMPLE

For the same patient as in the previous example, the pediatrician provides the office or other E/M service and interprofessional referral service at the same encounter with the patient present. The pediatrician spends 20 minutes in the interprofessional referral service in addition to the time of the E/M service. The pediatrician reports the appropriate office or other outpatient E/M service code (eg, 99213) and code 99452.

EXAMPLE

For the same patient and service as in the first example, the pediatrician spends 35 minutes preparing for and communicating with the consultant without the patient present on a date after the office visit. The physician reports an E/M code for services on the date of the office visit and prolonged service code 99358 on the date of the interprofessional referral service.

Reporting Time-Based Services

An interprofessional telephone/Internet/electronic health record (EHR) consultation is a time-based service. Time-based services must be supported by documentation of time and the context of the services provided during that time (eg, 10 minutes spent reviewing EHR data; 20 minutes spent discussing options of medical management versus surgery with referring physician and developing written report).

Interprofessional Assessment and Management 2019: Reporting Referring and Consulting Services ...continued from page 7

Prolonged Service Advantage

Consider prolonged service codes 99354–99357 or 99358 and 99359 when the time of an interprofessional telephone/Internet/electronic health record referral service exceeds the time requirements of these codes. Prolonged service codes are valued significantly higher (2.69–3.51 relative value units [RVUs]) than interprofessional referral service 99452 (0.74 RVUs).



NOTE: Prolonged service may not be reported in the same calen-dar month when reporting certain other timed E/M services such as chronic care management. See CPT® parenthetical instructions to the codes for each service for additional guidance when reporting multiple timed services in a calendar month.

The Figure is a decision tool that illustrates steps to determine the appropriate codes for reporting time spent by a referring physician or QHP preparing for referral and/or communicating with a consultant in an interprofessional consultation versus time of prolonged service.

Key PointsWhen interprofessional consultation services are provided, the following points are key in reporting these services:

• Do not report a request to assume treatment/management as an interprofessional assessment and management or referral service. A documented request for advice or opinion on diagnosis, treatment, and/or management is required as opposed to a request to assume management.

• Time spent in telephone or online consultation with the patient and/or family may be reported using codes 99441–99444 or 98966–98968, and the time related to these services is not included in the time attributed to interprofessional consultation services.

• Interprofessional consultation services are not reported if the consultant has provided a face-to-face service to the patient within the past 14 days or when the consultation results in scheduling of a face-to-face service within the next 14 days or at the consultant’s next available appointment date.

• Services of fewer than 5 minutes are not reported.

• Time is cumulative through the duration of the service, and each episode of time should be clearly documented to support the total time of service.

Please see Chapter 20 of Coding for Pediatrics 2019 for addi-tional information and examples of coding for interprofessional consultation services.

Interprofessional Referral Service Decision Tool

(See Current Procedural Terminology® instruction when reporting other time-based services in the same calendar month.)

≤15 min:not separately

reported

16–30 min:

99452

First h:99354

Add’l 30 min:99355

First h:99356

Add’l 30 min:99357

Determinedocumented

time of service.

Patient on-site Patient not present (off-site)

≥30 mina

Office or other

outpatient

Inpatient orobservation

Add’l 30 min:99359

First h:99358

Abbreviation: Add’l, additional.a Time must exceed the typical time of the related evaluation and management service provided on that date by 30 minutes or more to report codes 99354–99357. Verify applicability of prolonged service codes if reporting potentially overlapping services, such as chronic care management, in the same calendar month.

Treating physician prepares for and participates in interprofessional consultation service.



Peripherally Inserted Central Venous Catheters and Midline Catheter Placement Coding in 2019The October 2018 AAP Pediatric Coding Newsletter™ included a preview of the Current Procedural Terminology (CPT®) codes effective January 1, 2019, for image-guided insertion or replace-ment of peripherally inserted central venous catheters (PICCs). Here are some quick tips on reporting PICCs and services not reported as PICC insertion.

Midline CathetersCPT 2019 provides clear instruction that midline catheters are not PICCs. Midline catheters do not extend to the central venous system; midline catheters terminate in the peripheral venous system. To qualify as a central venous access catheter or device, the tip of the catheter/device must terminate in the subclavian, brachiocephalic (innominate), or iliac veins; the superior or inferior vena cava; or the right atrium. To report a midline catheter, see codes 36400, 36405, 36406, or 36410.

36400 Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein

36405 scalp vein

36406 other vein

36410 Venipuncture, age 3 years or older, necessitating the skill of a physician or other qualified health care professional (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)

PICC Coding and DocumentationThe Table includes the 2019 codes for reporting insertion of PICCs with or without imaging guidance based on the age of the patient and for replacement via the same venous access. Report codes 36572, 36573, and 36584 for PICC placement using imaging. For PICC placement using other guidance (eg, magnetic), report code 36568 or 36569. For replacement of a PICC without subcutaneous port or pump, through the same venous access, without imaging guidance, use unlisted procedure code 37799.

TIPCentrally Inserted Catheter

For placement of a centrally inserted non-tunneled central venous catheter, see codes 36556 and 36569.

Append modifier 52 (reduced services) when reporting PICC insertion with imaging guidance but without confirmation of the catheter tip. PICC insertion codes 36572, 36573, and 36584 include confirmation (ultrasound or x-ray confirmation) and documentation of the final catheter position. Chest radiographs (71045–71048) should not be reported in conjunction with codes 36572, 36573, and 36584.

Image documentation is required when reporting image-guided PICC placement/replacement. Documentation of PICC place-ment/replacement with ultrasound guidance should include evaluation of potential puncture sites, patency of the entry vein, and real-time ultrasound visualization of the needle entry into the vein.

Peripherally Inserted Central Venous Catheter 2019 Codes

Insertion Without Imaging Guidance Insertion With Imaging Guidance

▲36568 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age

●36572 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age

RVUsa 2.65 total facility RVUs 11.94 non-facility, 2.65 facility

▲36569 age 5 years or older ●36573 age 5 years or older

RVUs 2.72 total facility RVUs 11.21 non-facility, 2.45 facility

No separate code for replacement; use unlisted code 37799.

▲36584 Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement

RVUs 9.92 non-facility, 1.75 facility

Abbreviation: RVU, relative value unit.Symbols: ▲, revised code descriptor; ●, new code in 2019.a RVUs displayed are total non-facility and facility units.




Automated Testing and ResultWhen a single test instrument is completed by the patient via an electronic platform without physician, QHP, or technician adminis-tration and scoring, report code 96146.

●96146 Psychological or neuropsychological test administra-tion, with single automated, standardized instrument via electronic platform, with automated result only

Code 96146 does not include scoring by a health care profes-sional or interpretation and report. Results are generated via the electronic platform. If a test is administered by physician, QHP, or technician, do not report 96146. For brief emotional/behavioral assessment using a standardized instrument, see code 96127.

CPT® 2019: Psychological and Neuropsychological Testing ...continued from page 6

EXAMPLE

A child who is recovering from a concussion is provided a single computerized test (eg, ImPACT) for postconcussion symptoms. The patient completes the test and the automated result is included in the patient’s medical record. Code 96146 is reported in addition to the code representing the physician’s related evaluation and management service (eg, 99213).

When reporting testing services, be sure to verify the individual payer’s instructions for reporting. Verification of benefits prior to delivery of services is recommended.

We are receiving denials of code 51701 for insertion of non-indwelling bladder catheter when reported on the same date as an office evaluation and management (E/M) service. Is it incorrect to separately report these services?

No, not unless your practice is contractually obligated to follow a payer policy that does not allow separate payment for these services. Neither Current Procedural Terminology® instruction or National Correct Coding Initiative (NCCI) edits prohibit separate reporting of codes for an office or other E/M service (99201–99205, 99212–99215) and insertion of a non-indwelling bladder catheter (51701). Payers using NCCI edits will require modifier 25 (significant, separately identifiable E/M service) appended to the E/M service code to designate that the E/M service provided was significantly beyond work associated with the typical preservice and post-service

work of the catherization and is separately identifiable in the medical record. You may want to review the policies of the payers that have denied your claims to determine if your practice is contractually obligated to not bill separately for the insertion of a non-indwelling bladder catheter on the same date as an E/M service. Members of the American Academy of Pediatrics (AAP) may report coverage and payment issues with carriers using the AAP Hassle Factor Form, available at https://www.aap.org/en-us/professional- resources/practice-transformation/getting-paid/Pages/ Hassle-Factor-Form-Concerns-with-Payers.aspx or through state chapter pediatric councils. Chapter pediatric councils meet regularly with health plans to discuss access, quality, and coverage issues affected by health plan coverage and administration policies.

Peripherally Inserted Central Venous Catheters and Midline Catheter Placement Coding in 2019 ...continued from page 10

For repositioning of a previously placed central venous catheter under fluoroscopic guidance, report 36597. CPT specifically instructs to additionally report code 76000 (fluoroscopy [separate procedure], up to 1 hour, physician or other qualified health care professional time) used in conjunction with repositioning a previously placed central venous catheter.

Removal, without replacement into the same venous access, of a tunneled central venous catheter is reported with code 36589 for removal of a central venous catheter without a subcutaneous

port or pump or with code 36590 for removal of a central venous catheter with a subcutaneous port or pump regardless of whether inserted peripherally or centrally. Removal of a non- tunneled central venous catheter is considered to be inherent to the evaluation and management visit in which it is performed (CPT Assistant, December 2004).

See separate codes and instructions for centrally inserted central venous catheters (eg, 36555, 36556; unchanged in 2019) in your CPT coding reference (eg, manual, electronic application).


MIXED SOURCES12 | AAP Pediatric Coding Newsletter™ | http://coding.aap.org | November 2018

AAP Pediatric Coding Newsletter™ November 2018 | Vol 14, No. 2

0.5 Continuing Education Units

1. How does the Medicare Physician Fee Schedule

(MPFS) affect most pediatricians?

a. All payers’ fee schedules are based on the MPFS.

b. Pediatricians are only affected if a child is a Medicare

beneficiary.

c. Fee-for-service payment is typically based on

the MPFS.

d. Pediatricians are not affected by the MPFS.

2. Code 96116 is reported for

a. The first hour of neurobehavioral status examination

b. Only face-to-face time with the patient undergoing

neurobehavioral status examination

c. Neuropsychological examination

d. Each additional hour of neurobehavioral status

examination

3. Which of the following is not true of psychological

testing evaluation services?

a. The service time includes time integrating patient data.

b. The service is inclusive of test administration by a

physician.

c. Time spent in interpretation of test results is included.

d. Testing evaluation service of 30 minutes or less is

not reported.

Find your quiz answers at http://coding.aap.org.

4. Use of an electronic platform to administer a single

psychological or neuropsychological test is reported

with

a. 96127

b. Administration of a single test is included in an

evaluation and management (E/M) service.

c. 96146

d. 96138 52

5. A treating/requesting physician or other qualified

health care professional may report interprofessional

telephone/Internet/electronic health record referral

service(s) only when

a. The patient is not present at the time of service.

b. The service meets the requirements for a prolonged

E/M service.

c. Requesting that a consultant assume management of

all or part of a patient’s care

d. At least 16 minutes is spent preparing for referral

and/or communicating with a consultant.

AAP Pediatric Coding WebinarsPRESENTED BY THE

To register, visit www.aap.org/webinars/coding.

ARCHIVED AND AVAILABLE NOW FOR ON-DEMAND VIEWING

Proper Coding Using TimePresented by Margie Andreae, MD, FAAP

(Available until November 17, 2018)
