Excellent AAP Response to CMS Coding Changes

As such, the Academy is profoundly disappointed that CMS not only continues to bundle these services (ie, status indicator “B”) but fails to publish the RUC-recommended values for these codes.

Ten years ago, I couldn’t imagine the AAP using language like the above to argue on behalf of pediatricians – but they are now.  File this document in the “What Has The AAP Done For Me Lately” section.

Take a read through the PDF above (which is nestled in the coding section of the AAP’s site, where you can find other goodies) and you’ll see that the AAP has some very strong and reasoned positions about the CPT codes that affect independent practices.  They touch on vision screening and fluoride varnish, updating the new Health Screening (96160/96161) codes, their disappointment in the Feds still not getting it when it comes to inter-professional phone calls (see above), and they directly attack a threat to the 90460/90471 code set that is vital to your work (I need to get the details!).

Their biggest response, however, is saved for the invitation from CMS to discuss the consideration of E&M documentation guidelines.  That’s right, CMS is opening Pandora’s Box and thinking about how the E&M system should actually work.  Let’s agree: the present E&M coding system is farcical at times and does more to scare physicians than actually pay them properly OR record a note about the patient that makes sense.  Pediatricians are forced to jump through documentation hoops that benefit only the payers.

I won’t fully summarize the AAP’s position here, because it’s fairly long and there are some interesting nuances they capture.  Read it for yourself and take some pride in the work your Academy does for you.  Did they hit it all?  No, I could nitpick a few items, but I also realize they choose their words carefully and there may be implications or considerations I’m not aware of.  But I was particularly delighted with this statement: “More so than in other fields, pediatric scenarios rely on the collaborative participation of the parent and family in assessing history, considering diagnoses, and rendering management, and this reliance on parents and family not only influences the nature of history taking but also challenges physician decision-making. These complex social interactions inherent in general pediatric care underscore the value cognitive services play in establishing criteria for pediatric medical decision-making.

Those two sentences should be at the front of every pediatric coding document!

How about this? “To best represent pediatric care, CMS should expand the definition of time to go beyond just counseling/care coordination, expand allocation of time to also include office-based non-face-to-face time, and allow the clinician to select E/M to the highest representative level using either time or other components.”  Think of how revolutionary that concept would be.

I look forward to the AAP making sure the CMS and the rest of the medical establishment value children properly.

1 reply
  1. Susanne Madden
    Susanne Madden says:

    I almost wish there were an entirely different set of CPT codes specifically for pediatrics . . . that would address the cognitive nature of what peds do, and get away from the three-bullet restrictions of E & M coding today.

    Reply

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