Expanded Service Codes Prove Good for Pediatricians

There are two new care plan service codes that are hopefully going to solve the telephone billing problems and the care plan review for children that are not under a home health agency’s care. On January 1, 2006 the new CPT updates went into effect and pediatricians have seen three basic E/M changes.

1) The patient is not required to be under the care of a home health care agency, nursing home or hospice.

2) Supporting documentation must support use of modifier 25.

3) Confirmation consultation codes are 99271-99275.

The CPO codes will no longer have the rule that a hospice, home health agency or nursing facility has to supervise a child’s care. The current method means that you now have to report the CPO services only when a patient meets one of these three conditions:

a) patient is under a home health care agency, the codes are 99374 or 99375.

b) patient is in a nursing facility, codes are 99379 or 99380.

c) patient is on a hospice, codes are 99377 or 99378.

The new codes introduction is great news as they describe services that many special needs children require and previously lack of exact coding has caused some claims to only be partially paid or outright denied.

View all Articles by: Melissa Clark, CCS-P