Pediatric Coding Alert

Question: What is the correct way to bill when a child transfers from different units, say the neonatal intensive care unit (NICU) to a general care unit, within one hospital admission?

Alice Bryce
Rush Pediatric Medical Service Plan
Chicago, Ill.

Answer: For a continuous admission, when the patient is moved from one location to another within the same facility, the appropriate subsequent care codes would be used (99296-99298 for neonatal intensive care, 99231-99233 for subsequent hospital care). Only one admission code is allowed per admission. In the above example, the NICU visits would be coded 99295 for the admission, 99296-99298 for subsequent days in the same unit, and then the appropriate subsequent hospital care codes (99231-99233) billed once the patient is moved from the NICU. Note that if a child is moved to a different facility, then you could bill a discharge from the first facility, and an admission to the next facility.

This is not uncommon with neonatalogy services. Lets say a child is in one hospital as a very premature and sick baby and then needs to be transferred to a hospital across town for a cardiac procedure. Even though the same neonatalogy service cares for the child, a discharge is billed at one hospital and an admission is billed at the other.