Pediatric Coding Changes for 2018 Touch on Cardiology and Vaccines

Knowing Codes and How to Use Them Can Mean Revenue Differences of Thousands of Dollars

There are tons of new codes for 2018—but just a relative few impact those in pediatrics, said Donelle Holle, a coding expert who recently held a conference for AudioEducator, “2018 Coding Updates: Virtual Bootcamp.”

Still, it’s important to brush up on the changes. Knowing the codes and how they are used is key, of course. For example, billing just a few more 99214s per week instead of 99213s can increase revenue by thousands of dollars, Holle notes.

New Codes for Vaccines and Pulmonology

New CPT codes for 2018 related to pediatrics include:

  • Cardiology codes from 34701 to 34715
  • New evaluation and management codes related to behavior health conditions with psychiatry collaboration
  • Three new vaccines: two for the flu and one for shingles
  • Two new pulmonology codes


Holle pointed out the coding rules for Psychiatric Collaborative Care Management (PCCM):

  • 99492 is the first 70 minutes in the first calendar month for initial PCCM
  • 99493 is the subsequent first 60 minutes of the month for PCCM
  • +99494 is initial or subsequent PCCM when a visit for either of the above two is exceeded by a minimum of 16 to 30 minutes
  • The Behavioral Health Care Manager is someone with a master’s or a doctorate degree or who has specialized in behavioral health and who is directed by a treating physician

Revision: There’s A Difference between ‘Discharge Observation’ and ‘Observation Service’

Revised codes for 2018 include:

  • Observation Care: 99217 is discharge observation service; 99218-99220 is observation service, initial visit; and 99234-99236 is admission and discharge on the same calendar date.
  • 17250 is chemical cauterization of granulation tissue—it does not include sinus or fistula.


For radiology:

  • Codes 71010-70135 have been deleted and replaced by: 71045—radiologic examination, chest, single view; 71046—two views; 71047—three views; and 71048—four or more views.
  • New vaccine codes include 90682—influenza vaccine RIV4 and 90756—influenza vaccine ccllV4.
  • Codes with a revision in the schedule include ▲90621meningococcal recombinant lipoprotein vaccine, serogroup B (MenB-FHbp), 2 or 3 dose schedule, for intramuscular use, and ▲90651—human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonvalent (9vHPV), 2 or 3 dose schedule, for intramuscular use.

Reimbursement Plans: Boost Revenue with a 99214

Holle noted details of the reimbursement plan. For example:

  • All carriers pay differently based on their own fee schedule.
  • The difference between a 99213 and 99214 is $35, while the difference between a 99203 and 99204 is $57.
  • Performing just four additional 99214s per week nets a reimbursement difference of $7200.


Finally, Holle also noted that time is a key factor when counseling constitutes more than half of the visit in face-to-face comments with patients or parents. The physician has to document the amount of time spent in discussion and what was discussed. There are a number of codes for the time spent in consultation, ranging from 99201 (10 minutes) to 99245 (80 minutes).

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