Pediatric Coding Alert

Often a preemie needs to be transported from a rural hospital to one with a NICU. Or a newborn needs to be sent from one NICU to a hospital where surgery is going to be done. A pediatrician or neonatologist accompanies the baby on these trips, which are either by helicopter or ambulance.

Our doctor is going to be part of a transport team, writes Connie Arnold, billing clerk for Carlos Anaya, MD, a pediatrician and neonatologist in Eldorado, AK. We need to know what procedure code we can use for the doctor going with the critical patient in the ambulance or helicopter to transport the patient from one facility to another.

Critical Care Codes

One answer is to use the critical care codes, says Diane Kirkle, CPC, compliance coordinator for Creighton Medical Associates, the physician-health organization that is part of Creighton University in Omaha, NE. There is no location for the critical care codes, says Kirkle, noting that CPT states that critical care is usually, but not always, given in a critical care area, such as the coronary care unit, intensive care unit, respiratory care unit, or the emergency care facility. Patients being transported from NICU to NICU, if they are unstable, quality for critical care. But you must be providing face-to-face critical care to use these codes, Kirkle adds.

Only one doctor for any given time period can provide the critical care, she notes. What if two physicians are on the transport team? Then one can do it one hour, and the other can do it the other hour, she adds. And the blocks of time dont need to be that large. The pediatrician or neonatologist should be sure to use stop and start times when documenting, says Kirkle.

Actually, time is an essential element of the critical care codes. As CPT states, they are used to report the total duration of time spent by a physician providing constant attention to an unstable critically ill or unstable critically injured patient, even if the time spent by the physician providing critical care services on that date is not continuous.

The first hour of critical care should be reported as CPT 99291 . Each additional 30 minutes is reported as 99292. If you spend more time with the patient, you multiply the 99292 code for each 30 minutes.

Note: These codes can only be used when you are providing critical care services. Once youve transported the patient and are no longer by his or her side, you are responsible for getting yourself back home.

Other Alternatives

The critical care codes are what you would use if a child were truly critical -- on assisted ventilation, for example -- says Steven E. Krug, MD, FAAP, head [...]