Hospital Codes May Be Best:
Codes for Neonatal Intensive Care and Critical Care No Cure-all
Published on Wed Dec 01, 1999
The new definitions of critical care services (99291, 99292) and neonatal intensive care (99295, 99296, 99297, 99298) pose fresh challenges for pediatricians. They must now compare these codes with the hospital codes (99221-99223 for initial day, and 99231-99233 for subsequent days) and decide which to use.
The news superficially seems to be very good for general pediatricians. The initial neonatal intensive care code (99295) reimburses very well, and most pediatricians should be pleased to know that they can use it under limited conditions. These include: if a baby is 30 days of age or less at the time of admission, you must use 99295 for the first day and the subsequent codes (99296 for critically ill and unstable, 99297 for critically ill and stable, and 99298 for recovering very low birth weight babies).
But due to coding technicalities, many times the general pediatrician is not going to be able to use either the neonatal intensive care codes or the critical care codes. Take the common situation of the pediatrician caring for a recently delivered baby who is critical in a hospital that does not have a neonatal intensive care unit (NICU). The specialist looks after the baby until transport arrives. Heres how coding affects the bottom line: The neonatal intensive care codes are 24-hour codes and can be billed only once per patient per day.
Thus, the original pediatrician cant use 99295 because the receiving hospital will bill it. The pediatrician and receiving hospital cant both be paid for it, and as a general rule, the receiving hospital with the NICU will get paid for it (although technically, health plans pay whichever provider files a global fee first).
Critical Care Codes
The critical care codes are often out of reach as well. The introduction to critical care services in CPT 2000 seems to provide that pediatricians can use them. Critical care services provided to neonates (30 days of age or less at the time of admission to an intensive care unit) are reported with the neonatal critical care codes 99295, 99296, 99297 and 99298. Yes, but only if you are not transporting the child to a NICU.
Richard Molteni, MD, FAAP, says hospital codes offer a path to payment. He is a neonatologist who is a member of the CPT editorial panel and a national expert on coding for the treatment of critically ill newborns. Molteni says the general pediatrician who is taking care of these babies for several hours while waiting for transport should add up the hospital code, prolonged services and the procedures performed. The private pediatrician often will be better reimbursed to bill initial hospital care, prolonged services and all of the procedures [...]
