Neonatal Care: Out with the Old, In with the New

New neonatal care codes add beats to little hearts

By Kimberley Floyd Waldman, CPC, CPC-H, CCC, MCMC, CHA

Four million babies are born in the United States each year. Of these 4 million babies, 500,000 are born premature or less than 37 weeks old. Because premature births are so common, neonatal medicine is essential. The care provided in the first few fragile moments of life lays the foundation for a baby’s health and gives hope to the parents for a positive future.
For proper usage of the neonatal CPT^® codes, the baby must be 28 days of age or less with the date of birth counting as day one. Although neonatal intensive care services CPT^® codes are new in 2009, the definition of critical care services remains the same. By CPT^® 2009’s definition, “a critical illness or injury” is defined as one that “acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.”
In 2009, to report a critically ill neonate’s initial inpatient neonatal critical care, 28 days of age or less, CPT^® code 99468 Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less replaces 99295 Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less. Another addition for 2009 is CPT^® Code 99472 Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age for day three.
This CPT^® code would be used as the neonate passes from 28 days of age to 29 days of age and still remains in critical care.
The subsequent inpatient neonatal critical care, per day, for the evaluation and management (E/M) of a critically ill neonate also gets a new code this year with CPT^® code 99469 Subsequent inpatient neonatal crucial care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less replacing CPT^® code 99296 Subsequent inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less.
For example, a 27-day-old baby is admitted to the neonatal intensive care unit (NICU) and remains there through 29 days of age. The correct billing for this would be 99468 for the initial day, 99469 for day two, and 99472 Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age for day three.
Unlike adult critical care codes, neonatal critical care codes are not based on time spent rendering care to the patient. The NICU is not required as the place of service; however, if the critical care provided for a neonate is in the outpatient setting as in the emergency department (ED), critical care codes 99291 Critical care, evaluation and management of the critically injured patient; first 30-74 minutes and 99292 Critical care, evaluation and management of the critically injured patient; each additional 30 minutes would be the correct codes to report. When billing these charges, remember validation of neonatal critical care codes is not dependent on the provider’s specialty (that is, neonatologist vs. cardiologist) performing the critical care. For proper CPT^® code selection, factor the baby’s age and verify that documentation warrants a critical care charge. For proper CPT^® code selection, factor the baby’s age and verify that documentation warrants a critical care charge. Contrary to critical care charges for patients over 24 months of age, neonatal critical care CPT^® codes can only be reported by a single physician, once per day, and per patient in a given setting.
The intensive neonatal care codes, 99477 Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or less, who requires intensive observation, frequent interventions, and other intensive care services continues to be used for initial hospital care per day for neonate’s evaluation and management who requires intensive observation, frequent interventions, and other intensive care services. According to the 2009 CPT^® book, “these services are for neonates who are not critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or frequent vital sign monitoring, heat maintenance, enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, and constant observation by the health care team under direct physician supervision.”
New for 2009 are three subsequent intensive care CPT^® codes based on a low birth weight neonate or infant and current body weight. CPT^® code 99478 Subsequent intensive care, per day, for the evaluation nd management of the recovering very low birth weight infant (present body weight less than 1500 grams) is for the subsequent intensive care, per day for the recovering very low birth weight infant (present body weight less than 1500 grams), 99479 Subsequent intensive care, per day, for the evaluation dn management of the recovering low birth weight infant (present body weight of 1500-2000 grams) is for the low birth weight infant (present body weight of 1500-2500 grams) and 99480 Subsequent intensive care, per day, for the evaluation and management of the recovering infant (present body weight of 2501-5000 grams is for the subsequent intensive care, per day, of the recovering infant weighing 2501-5000 grams.
For example, an infant weighs 1499 grams on days one through days four. On day five the infant weights 1500 grams. The billing for this would be 99478 x 5
(days one – four) and 99479 x1 (for day five),
For the sick neonate, less than 28 days of age but more than 5000 grams, who does not require intensive or critical care services, continue using subsequent hospital care codes 99231-99233.
Given the significant changes in neonatal coding for 2009, education of physicians, nurses, billing, and support staff are a necessary part of the transition as we continue to care for the littlest of us.
 

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