Pediatric Coding Alert

Many neonatologists and pediatricians struggle with the nuances of switching among age-based critical care codes. But remembering the neonate-to-pediatric milestone will ensure that coders and physicians submit audit-proof claims. You probably anticipated, as many pediatric coders did, that the creation and revision of 99293-99296 would streamline neonatal and pediatric critical care coding. But many experts find that the new and revised codes require a thorough knowledge of the age-specific definition. Questions arise mainly when a patient transitions from 30 to 31 days of age, and from 24 months to greater than 24 months of age, says Joel F. Bradley Jr., MD, FAAP, American Academy of Pediatrics CPT adviser. These great divides from neonate to pediatric and older child to adult require code shifts, which is where understanding the intricacies of the new CPT Codes becomes important. Get out of Town at 31 Days The first hot spot occurs when a neonate remains critically ill past 30 days of age. When a pediatrician treats a critically ill neonate who changes from 30 to 31 days of life, you should choose the code based on the patient's age neonate or pediatric. The age change from 30 to 31 days of life requires you to shift from neonatal critical care codes (99295, Initial neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 days of age or less; and 99296, Subsequent neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 days of age or less) to pediatric subsequent critical care (99294, Subsequent pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child). CPT considers the care subsequent because the neonatologist has already provided care to the patient. Do not fall into the trap of thinking that because you have not reported a pediatric critical care code for the patient that you should assign initial pediatric critical care (99293, Initial pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child).

"The advent of new pediatric critical care codes makes the transition from subsequent neonatal critical care to subsequent pediatric critical care very clear," Bradley stresses. Abolish Old Methods This transitional coding may fly in the face of previously held coding tenets. Before 2003, you could continue to use the same neonatal critical subsequent care code (99296 or 99297) beyond 30 days of age as long as the patient's care was provided during a single episode of critical care, Bradley says. The creation of the new pediatric [...]