What type of service should be reported for a visit to reevaluate the health status of a child in foster care who is being transitioned to a new foster home? The child has already had a preventive service examination earlier this year.
The answer to your question depends on the payer and type of service rendered. Some Medicaid plans specifically state that even if a child in foster care had a recent well-child check, the child is eligible for a full Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program examination with each placement. Note also that more frequent preventive service encounters are recommended for children in foster care. You can reference this information on the Healthy Foster Care America Web site in the manual Fostering Health: Health Care for Children and Adolescents in Foster Care, 2nd Edition, at www2.aap.org/fostercare/FosteringHealth.html. In particular, preventive service recommendations include
Monthly visits up to 6 months of age
Semiannual visits beyond 2 years of age through adolescence
Recognition that given the high incidence of complex medical, developmental, and mental health conditions in this population, primary care physicians will need to schedule additional visits on a case-by-case basis
Most children in foster care are covered by Medicaid plans, which may have specific reporting guidelines including modifiers to indicate mandated or partial preventive services. Modifiers may include Medicaid levels of care as defined by the state (U1–UD) or other Healthcare Common Procedure Coding System Level II modifiers such as TJ (program group, child and/or adolescent) or H9 (court-ordered). International Classification of Diseases, Ninth Revision, Clinical Modification code V61.06 (family disruption due to child in foster care or in care of non-parental family member) should be included on the claim in addition to well-child and other identified conditions. Grief reaction and other adjustment disorders may be reported with codes 309.0–309.9. Signs and symptoms involving emotional state may be reported with codes 799.21–799.29.
If the child is having significant problems that are addressed along with a significantly reduced preventive service, a problem-focused evaluation and management (E/M) visit may be more appropriately reported. Some plans may pay for an interval preventive service and a significant, separately identifiable problem-oriented E/M service on the same date when modifier 25 is appended to the problem-oriented E/M service code (eg, 99213-25). Be sure to verify the coverage and reporting requirements of the payer to appropriately report these services.
Is code 31720 correctly reported for nasopharyngeal/tracheal suctioning done in the office for clearance of an infant's airway or obtaining a specimen for diagnostic testing (eg, respiratory syncytial virus, flu)?
The Current Procedural Terminology (CPT®) descriptor for code 31720 is catheter aspiration (separate procedure); nasotracheal. This rather vague descriptor may mislead one to report this code for nasopharyngeal or upper trachea suctioning. However, the code is included in a section of codes for procedures on the trachea and bronchi and is intended for the insertion of a suction catheter through the nasal passage and pharynx into the trachea to aspirate accumulated secretions or foreign material from the trachea and bronchi. This procedure is assigned 1.06 physician work relative value units, implying this is a procedure requiring the skills of a physician or other qualified health care professional. There is currently no CPT code describing nasopharyngeal suctioning, which is considered a component of an E/M service.