Pediatric Critical Care Codes Moved for Easier Coding

CPT® 2009 codes for saving young lives consolidated

By G. John Verhovshek, MA, CPC

CPT® 2009 includes considerable revisions to codes and guidelines describing inpatient pediatric critical care. Codes 99293-99296 were deleted and replaced by four new, age-specific codes to identify the initial and subsequent date(s) of service. This brings all the critical care codes for neonatal and pediatric patients together in the section. The codes are as follows:

Certified Pediatrics Coder CPEDC

CPT®                  Description

99471                  Initial 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

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

99475                  Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age

99476                  Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age

These codes apply only for direct, physician-delivered care to the critically ill or critically injured patient, age 29 days through 24 months, or 2-5 years of age. CPT® defines a critical illness or injury for all patients, regardless of age, as impairment of one or more vital organ systems, “such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.”

Coders, physicians, and payers should note that critical care is not place-of-service (POS) dependent. Not all patients in the hospital critical care unit, for instance, will qualify for critical care as defined by CPT®. Conversely; a patient outside the critical care unit may qualify for critical care. This article addresses the age-specific codes within that section of CPT®.

Related Services

Critical care includes many related services, such as X-rays, gastric intubation, and more. CPT® lists all included services in the Critical Care Services guidelines preceding adult critical care codes 99291-99292. Pediatric critical care codes 99471-99476 include all the same services as adult critical care, plus additional services (such as ventilator management and lumbar puncture) as listed in the Inpatient Neonatal and Pediatric Critical Care services guidelines. Always check your CPT® manual prior to coding for additional services with critical care to ensure additional services are separately reportable.

Only one physician may report pediatric critical care for the same patient for any calendar day. When physicians from different groups provide same-day services at two separate facilities, the referring physician reports critical care and the receiving physician reports the admission service. If two separate physicians from different groups provide critical care on different days, each physician may report the appropriate pediatric critical care code for his respective service.

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Emergency Services

CPT® 2009 also includes two new, age-specific (24 months of age or less) codes for pediatric critical care patient transport, to replace now-deleted codes 99289 and 99290. The codes are:

CPT®                  Description

99466                  Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less; first 30-74 minutes of hands-on care during transport

+99467                  Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less; each additional 30 minutes (List separately in addition to code for primary service)

These services require direct, face-to-face physician care. Physician direction of emergency care using two-way communication does not qualify as pediatric critical care transport and should instead be reported using 99288 Physician direction of emergency medical systems (EMS) emergency care, advanced life support.

Codes 99466 and 99467 are time-dependent, as is apparent by the code descriptors. Reporting time begins when the physician assumes primary responsibility of the patient at the referring facility, and ends when the receiving facility accepts responsibility for the patient, according to CPT® guidelines. As always, physicians are best served to document precise start and stop times, as this will help ensure accurate coding and complete reimbursement.

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G. John Verhovshek, MA, CPC, is AAPC’s director of clinical coding communications.

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