A Guide on Pediatric Coding E/M Updates 2021

Did you ever wonder what could be the main focus in pediatric coding changes? Current Procedural Terminology mainly concentrates on office or outpatient evaluation and management updates for the year 2021. Additional changes are attached to pediatric coding updates those are set to be most significant for the practice.

The below pediatric coding changes are as follows:

E/M services updates in Pediatric Coding Services:

  • A new guide was introduced regarding care management plans. Of course, a complete plan is based on mental, physical, cognitive, social, functional and environmental evaluation.
  • Its main intention is to provide concise and simple outer look of the patient history and be a better resource for patients, caregivers, healthcare professionals and practitioners in need.
  • A typical care management plan is not restricted and limited. It includes:
  1. List of problems
  2. Expected outcome as well as prognosis
  3. Treatment goal those are measurable
  4. Cognitive assessment
  5. Functional assessment
  6. Symptom management
  7. Planned interventions
  8. Medical management
  9. Environmental evaluation and
  10. Caregiver management.
  • It’s necessary to have an interaction and coordination with other resources for emergencies other than healthcare professionals and caregivers.
  • These elements are supposed to be a guide for creating a clear path for care management plan instead of strict requirements.
  • Care management plan should indeed include, goals those are specific and achievable for particular conditions and are relevant to the patient’s lifestyle and healthcare.
  • If possible, the treatment plans must also involve goals that are measurable and bound with time.
  • The care management plan should be reviewed periodically and updated at least once in a year based on goal changes.
  • Electronic care management plan is supposed to be printed, documented and share with patients or healthcare professionals.

Chronic care management plans:

  • In pediatric coding, the code 99490 is reported for twenty minutes of the time spent in core management activities.
  • The code 99439 is reported in conjunction with 99490 for each additional 20 minutes of the staff time spent in care management activities up to a maximum of 60 minutes total time.
  • 99490: This code is for Chronic care management services with the below required elements.
  1. Chronic conditions more than two are expected to last for 12 months of time and sometimes until patient’s death.
  2. Chronic conditions actually take patients to a greater risk of death, acute exacerbation and decompensating or functional decline.
  3. A complete care management plan is established, implemented, revised or monitored.
  4. The first twenty minutes of clinical staff time is directed by healthcare professionals or other care professional as per calendar month.
  • 99439: This code is for every additional 20 minutes of clinical staff time mentioned by a healthcare professional or other qualified provider, per calendar month.

Cardiovascular Surgery:

  • New procedure codes are added to pediatric coding. Two codes are deleted simultaneously and they are 92992 and 92993.
  • Pediatric codes 33741 and 33745 are used to report creation of effective intracardiac blood flow in the setting of congenital heart defects.
  • 33741: This code is used for the percutaneous creation of improved atrial blood flow, especially in infants lesser than or equal to 4 kg with congenital heart disease.
  • 33745: This code is for intracardiac shunt creation by stent placement to establish improved intracardiac blood flow. For example, atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard or Senning or Warden baffles.
  • 33746: This code is for describing each additional intracardiac shunt creation by stent placement at a different location during the same session as the primary intervention 33745.
  • 33741: This code is for Transcatheter atrial septostomy for congenital cardiac anomalies to create effective atrial flow, involving all imaging guidance by the proceduralist, during performance, and any method.
  • 33746: This code is for each additional intracardiac shunt location.

Audio logical Functional Tests:

  • There are three new codes added under auditory evoked potentials. 92585 and 92586 are deleted.
  • Code 92650 is used for screening service. This code is for auditory evoked potentials and screening of auditory potential with broadband stimuli, automated analysis.
  • 92651: This code is added to report post-screening follow-up for auditory evoked potential for hearing determination. It’s also for hearing status determination, broadband stimuli, with interpretation and report
  • 92652: This code is added for threshold estimation at multiple frequencies.
  • 94617: This code is for Exercise test for bronchospasm, including pre and post spirometry and pulse oximetry with electrocardiographic recordings.
  • 94619: This code is used without electrocardiographic recording.
  • 0615T: This code is for Eye movement analysis without spatial calibration, with interpretation and report.
  • The Code 0615T has been added because of no specific Category III code for eye movement analysis without spatial calibration.
  • Eye movement analysis without spatial calibration is actually performed to diagnose conditions like concussion by detecting deficits in patient’s ability to fix and gaze upon a specific object.

The Major Pediatric coding changes in 2021:

  • Medical decision making (MDM) eliminates physical and history. Earlier as known, healthcare professional’s codes were based on three key components. In 2021 medical decision making alone is added into leveling. History and physical are eliminated.
  • Moreover code selection doesn’t depend on new and established patients from now on.
  • Visit codes are mostly based on patient’s medical decision making.
  • Patient’s encounter should meet two of three rules where the focus or concentration is completely on medical decision making and documentation including leveling which makes it more easy for healthcare professionals.

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