Pediatric Coding Alert

You conquered neonatal-to-pediatric transitional coding, but one great divide remains: finishing the terrible twos. Although CPT made the initial shift from "neonatal" to "pediatric" critical care quite clear, some ambiguity remains regarding how you should code a pediatric patient who remains critically ill past 24 months of age, says Joel F. Bradley Jr., MD, FAAP, a pediatrician for Premier Medical Group in Clarksville, Tenn. He's an Adult at 24+ Similar to the first great divide from neonate to pediatric, the age change from two years to two years and a day requires shifting between CPT subsections. When a pediatric patient reaches 24 months plus one day of age, you should no longer report pediatric critical care codes (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; and 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), Bradley says. "You should instead start reporting the hourly critical care codes (99291-99292), which may be used for adults and older children, once the critically ill patient is over 24 months of age." The Revisions Never End To emphasize that you should switch from the pediatric critical care codes to the adult critical care codes, the American Academy of Pediatrics (AAP) requested a revision to the codes for 2004. The AAP suggested that CPT update the neonatal and pediatric critical care services guidelines to "the critically ill or critically injured child older than 24 months of age would be reported with hourly critical care service codes (99291-99292)." The alteration would replace "two years" with "24 months," eliminating the confusion the general term "older than two years" causes (see page 21, CPT Professional Edition , middle of third paragraph), Bradley says. In addition, the language would remove the location from the description, which now reads "when admitted to an intensive care unit."

The critical care codes are not location-specific. CPT does not require a neonate to be in a neonatal intensive care unit (NICU) or a pediatric to be in a pediatric intensive care unit (PICU) to report these codes. The patient's status as critically ill determines the code, not his or her physical location, says Richard A. Molteni, MD, FAAP, vice president of Children's Hospital & Regional Medical Center in Seattle. Transition From Pediatric to Adult Location is not crucial to the critical care codes because hospitals may provide treatment in various departments based on their facilities. A rural hospital in Florida, for instance, may not have a PICU and provides all [...]