CODING NUMBER 2 EXAM 2

Newborn Care Services

-Assigned for normal newborns within the first 28 days of life -Non-normal newborn care should be reported with either Hospital Inpatient Services codes (99221-99233) or the Neonatal Intensive and Critical Care Services codes (99466-99469, 99477-99480) -Initial visits, subsequent visits, admit and discharge same date -Follow-up visits to pediatricians are reported with E and M codes such as Office or Other Outpatient, Preventative Medicine -When delivery room attendance or delivery room resuscitation services are required, report codes 99464/99465; these codes may be reported in conjunction with the Newborn Care Services, Pediatric critical Care or Initial and Continuing Intensive Care codes.

Complex Chronic Care Coordination Services

-Codes represent patient-centered management and support services provided by physicians, other qualified health professionals and clinical staff to an individual who resides at home or in a domiciliary, rest home, or assisted living facility. -Typical patients have 1 or more chronic continuous or episodic health conditions expected to last 12 months, or until the death of the patient and that place the patient at significant risk of death, acute exacerbation/decompensation or functional decline. -Reported only once per calendar month -Time-based codes, can be face-to-face or non-face-to-face

Transitional Care Management Services

-Codes represent services for an established patient whose medical and/ or psychosocial problems require moderate or high complexity decision making during transitions in care from an inpatient hospital setting, partial hospital, observation status, or skilled nursing facility/nursing facility, to the patients community setting. -It begins upon the date of discharge and continues for the next 29 days. -Codes based upon type of decision making -Only one individual may report and only once per patient within 30 days of discharge

Other types of Services

-Domiciliary, Rest Home (Boarding home), or Costodial Care Services -Domiciliary, Rest Home (Assisted Living Facility), or home Care Plan Oversight Services -Home Services

Emergency Department Services

-ED codes may be used by all physicians- not just those who are working in the ED (considered ED physicians) -Code 99285- typically requires that the 3 Key Components are documented; however this rule is relaxed based upon "the constraints imposed by the urgency of the patients' clinical condition and/or mental status" -MD directed emergency care through outside voice communication to transporting staff is reported with 99288 (Other Emergency Services)

Hospital Observation Services

-If admitted and discharged on the same date, do not assign these codes; instead assign a code from 99234-99236 (Observation or Inpatient Care Services- including admission and discharge services) -Codes are available to show initial visit and subsequent visits and discharge- day management -Discharge-day management code is only assigned if the discharge date is different from the initial visit date -If a patient is seen in the office (or other sites such as ER, nursing facility) then subsequently admitted as an observation on the same date as the office visit, only one code is reported: the initial observatin code -If a patient is on observation status and is subsequently admitted to the hospital on that same date by the same physician, only one code is reported: the Initial Hospital Care code.

Hospital Inpatient Services

-Initial Hospital Care codes- might be different than the date patient was actually admitted.

Office and Other Outpatient

-Note requirements for code selection- new patient vs. established patient. -If a patient is seen i nthe office then subsequently admitted as an inpatient on the same date as the office vist, only one code is reported: the Initial Hospial code (not the office visit code)

Consultations

-Note the requirements for a consultation-see text; note the difference between a consultation and a referral -consultations that are requested by a patient/ family member are not coded as consultations -Only one Inpatient Consultation code should be reported per admission. If a consultant has to make subsequent visits to the inpatient, these visits are coded usng the Subsequent Hospital care codes.

Critical Care Services

-These codes are based upon the length of time a physician spends with a patient who is receiving Critical Care -When counting the amount of time spent, the physician should be providing direct delivery of medical care with his/ her full attention on the patient; no other services may be provided to other patients during this time frame -The time spent is per date, therefore the time spent does not have to be continuous (can be time spent in the morning and time spent in the evening); also does not have to occur at the patient's bedside -Code 99291 is assigned for the first 30-74 minutes; 99292 is reported for the additional blocks of time -If the critical care time is less than 30 minutes, do not assign these codes -Note the services that are included in this category -When medical crisis is stabilized, stop using the Critical Care codes

Physician Standby Services

-These services are provided at the request of another physician -The physician providing standby services cannot provide care or services to other patients during the period of standby -If period of standby ends with the physician performing the procedure (for which he/she was on standby), the Physician Standby Services cannot be assigned

Nursing Facility Services

Care Provided to patients in nursing facilities (such as skilled nursing, intermediate care or long-term care facilities)

Case Management Services

99363-99368

Care Plan Oversight Services

99374-99380

Preventative Medicine Services

99381-99429 New Patient, Established Patient -If abnormalities are encountered during a Preventative Medicine visit: If these abnormalities require additional work-up and the physician performs the key components of an E and M service, then the appropriate E and M code should be used in addition to the Preventative Medicine code. Modifier 25 will also be assigned to the E and M code. Counseling Risk Factor Reduction and Behavior Change Intervention: assigned when physician is promoting health and prevention of illness or injury.

Non-face-to-face physician services

99441-99444 (phone and online)

Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services

Pediatric Critical Care Transport: 99466 and 99467 Physical attendance and direct face-to-face care by a MD during the inter-facility transport of a critically ill/injured pediatric patient 24 months of age or less -99291,99292 is reported for MD attendance during transport of a critically ill/ injured patient over 24 months of age Must be direct face-to-face contact with patient during transport Note procedures which are included in these codes and should not be assigned seperately

Initial and Continuing Intensive Care Services

Represents non-critical care for low birth weight infants (28 days or younger) who require intensive observation, frequent interventions, or other intensive management services Includes the Initial Hospital Care code then subsequent Care codes chosen based upon birth weight of infant.

Inpatient Neonatal and Pediatric Critical Care

Service for the care of a critically ill neonate 28 days of age or less Only reported once per day by a single physician -critical care services which are provided by a second physician are reported using the Critical Care section (99291-99292) Note all of the services/ procedures which are included in the codes cannot be coded seperately

Inpatient Neonatal and Pediatric Critical Care

Service for the critically ill infant or young child from 29 days through less than 6 years. Age-based codes If age is 6 years or greater, assign codes from the Critical Care section (99291-99292) If a neonate or pediatric patient are provided critical care services in the outpatient setting, report using codes from the Critical Care section (99291-99292)

Prolonged Services

Services which are beyond the usual services provided in either the inpatient or outpatient setting. The services provided may be either With Direct (face-to-face) Contact or Without Direct Contact. -Time-based codes; time does not have to be continuous -These codes are add-on (+) codes and must be assigned with the applicable E and M service code -the prolonged services codes can be assigned with E and M codes from any level of CPT

Pediatric Critical Care Patient TRansport

Used to report the control physician's non-face-to-face supervision of interfacility transport of a critically ill/ injured pediatric patient 24 months of age or less; the control physician is the physician directing transport services.