Editor’s note: This is the first of two articles on Current Procedural Terminology (CPT) code changes for 2017. The second article will include more information on the new moderate sedation codes and provide clarification on the new health risk assessment codes.
● New code
▲ Revised code
# Re-sequenced code
Influenza vaccines
Starting Jan. 1, many influenza codes will be revised to remove the age indicator and add a dosage. See table.
|
Influenza codes revised |
2016 (Age of patient) |
Jan. 1, 2017 (Dosage) |
|
▲90655, ▲90657, ▲90685, ▲90687 |
6-35 months |
0.25 mL dosage |
|
▲90656, ▲90658, ▲90686, ▲90688 |
Older than 3 years |
0.5 mL dosage |
A new code also will be added for quadrivalent cell cultured influenza vaccine indicated for use in those 4 years of age and older.
#90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
Although code 90674 was released on July 1, it does not take effect until Jan 1. The vaccine that is reported under this code already is available and on the market. The Academy will be updating its coding site, http://bit.ly/2cpXkqS, to help you navigate proper coding until Jan 1.
Some payers have said they will accept the unlisted vaccine code (90749) until 90674 is implemented on Jan 1. Use of code 90661, which is for the trivalent cell cultured influenza vaccine, is not being recommended. Only use that code when specifically required by the payer.
Health risk assessment
On Jan. 1, there will be a code for reporting administration and scoring of a caregiver-focused health risk assessment such as a recommended routine maternal depression screen conducted for the benefit of the infant. Code 96161 will be reported for services on and after Jan. 1, 2017, for use of a standardized instrument to screen for health risks in the caregiver for the benefit of the patient. It is intended that code 96161 will be reported to the patient’s health plan as it is a service for the benefit of the patient. Payer guidance is not yet available and may vary across health plans.
In conjunction with this change, code 99420 (administration and interpretation of health risk assessment instrument [e.g., health hazard appraisal]) will be deleted and replaced with code 96160 for administration of a health risk assessment for the benefit of the person completing the assessment.
●96160 Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation, per standardized instrument
An example of this could be the CRAFFT tool to screen for alcohol or drug use.
●96161 Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument
In the case where the mother is a patient (e.g., encounter for breastfeeding-related condition in the mother), the indications (i.e., symptoms vs. routine screening) for administration of a depression inventory will determine the code reported. If the mom is the patient and depression is suspected, report 96160 for the depression screen. However, if the encounter is focused on the baby and there is a concern for maternal depression and the Edinburgh postpartum screen is done, report 96161. Both codes now require that the instruments be standardized and scorable.
Partial exchange transfusion
A new code is added for reporting partial exchange transfusion (e.g., for hyperviscosity in a neonate). For complete exchange transfusions in the neonate, continue to report code 36450.
●36456 Partial exchange transfusion, blood, plasma or crystalloid necessitating the skill of a physician or other qualified health care professional
Becky Dolan, in the AAP Division of Health Care Finance, contributed to this article.
