Pediatric Coding Alert

Experts reveal how 5 revamped instructions will simplify your 99289-99296 options

If critical care codes confuse you, you'll welcome CPT Codes 2004's new guidelines that clarify some of your major neonatal and pediatric coding dilemmas.
 
CPT 2003's introduction of neonatal and pediatric critical care services left some billing ambiguities, such as how you should report in-office critical care, in-office critical care that results in a transfer of care or inpatient hospitalization, and interfacility transports of patients more than 2 years of age. You may also not have known how to code for a critically ill child who remains critically ill past 24 months of age or for delivery-room procedures that your pediatrician provides before initial neonatal critical care. To solve your challenges, the AMA revised the critical care guidelines to ease pediatric coding.
 
Starting Jan. 1, 2004, coding experts recommend that you bill for critical care services based on the following five guidelines. 1. For Outpatient Critical Care, Assign 99291-99292 The biggest pediatric change for 2004 specifies that you should assign 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (... each additional 30 minutes [list separately in addition to code for primary service]) for all outpatient critical care services, says Richard Molteni, MD, FAAP, a neonatologist and vice president of Children's Hospital & Regional Medical Center in Seattle. "The patient's age no longer matters."
 
You may report 99291-99292 in the following locations: the office (place-of-service code 11), urgent care facility (POS 20), pediatric outpatient floor (POS 22, outpatient hospital), hospital emergency room (POS 23) and ambulance (POS 41, land; POS 42, air or water), says David G. Jamiovich, MD, transportation code creator and pediatric transport program medical director at Hope Children's Hospital in Oak Lawn, Ill. But don't use 99291-99292 in the delivery room, which is part of inpatient hospital care (POS 21). 2. Reserve 99293-99296 for Inpatient Critical Care If you struggle with coding for outpatient critical care services that result in transfers of care, CPT's critical care revision simplifies your options, Jamiovich says. When your pediatrician provides outpatient critical care services before sending the patient to a specialist for inpatient services, you should report 99291-99292, he says. The specialist, such as a neonatologist, would then report the codes for global neonatal critical care (99295, Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 days of age or less; 99296, Subsequent inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 days of age or less) or pediatric critical care (99293, [...]